Selecting an optimal staging system for hepatocellular carcinoma

Comparison of 5 currently used prognostic models

Authors

  • Chia-Yang Hsu MD,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    3. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
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  • Cheng-Yuan Hsia MD,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yi-Hsiang Huang MD, PhD,

    1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Chien-Wei Su MD,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Chieh Lin MD,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Pui-Ching Lee MPH,

    1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Che-Chuan Loong MD, PhD,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Jen-Huey Chiang MD,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Teh-Ia Huo MD,

    Corresponding author
    1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
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    • Fax: (011) 886-2-2873-9318

  • Shou-Dong Lee MD

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract

BACKGROUND:

Selecting an appropriate staging system is crucial to predict the outcome of patients with hepatocellular carcinoma (HCC). The optimal prognostic model for HCC is under intense debate. This study investigated the prognostic ability of the 5 currently used staging systems, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Japan Integrated Scoring (JIS) system, tumor-node-metastasis (TNM), and Tokyo score, for HCC.

METHODS:

Between 2002 and 2008, 1713 prospectively enrolled HCC patients were compared for their long-term survival by using the Akaike information criterion (AIC) according to the staging or scoring methods of these 5 models.

RESULTS:

The mean and median follow-up duration was 18 and 14 months, respectively. Among all patients, the CLIP staging system had the lowest AIC value in comparison with other systems in the Cox proportional hazards model, followed by the Tokyo score, JIS score, BCLC staging system, and TNM staging system. Patients undergoing curative treatment had a significantly better survival in comparison with patients undergoing noncurative treatment (P < .001). When the predictive accuracy of the staging systems was analyzed according to treatment strategy, the CLIP staging system had the lowest AIC value and remained the best prognostic model in patients undergoing curative (801 patients) and noncurative (912 patients) treatment.

CONCLUSIONS:

The CLIP staging system is the best long-term prognostic model for HCC in a cohort of patient with early to advanced stage of HCC. Its predictive accuracy is independent of the treatment strategy. Selecting an optimal staging system is helpful in improving the design of future clinical trials. Cancer 2010. © 2010 American Cancer Society.

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