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Article first published online: 7 JAN 2013
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 57, Issue 1, pages 112–119, January 2013
How to Cite
Hsu, C.-Y., Lee, Y.-H., Hsia, C.-Y., Huang, Y.-H., Su, C.-W., Lin, H.-C., Lee, R.-C., Chiou, Y.-Y., Lee, F.-Y. and Huo, T.-I. (2013), Performance status in patients with hepatocellular carcinoma: Determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system. Hepatology, 57: 112–119. doi: 10.1002/hep.25950
Potential conflict of interest: Nothing to report.
Supported by grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH101-TD-C-111-007), Taiwan, from Taipei Veterans General Hospital (V101C-170), Taipei, Taiwan, and from the Ministry of Education, Aim for the Top University Plan (101AC-D101), Taiwan.
- Issue published online: 7 JAN 2013
- Article first published online: 7 JAN 2013
- Accepted manuscript online: 13 JUL 2012 04:24PM EST
- Manuscript Accepted: 25 JUN 2012
- Manuscript Received: 17 APR 2012
Performance status is included in the Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma (HCC). Few studies specifically evaluated the role of performance status in patients with HCC. This study investigated its distribution, determinants, and prognostic impact, aiming to improve the performance of the BCLC system. A total of 2,381 HCC patients were enrolled. Performance status was determined according to the Eastern Cooperative Oncology Group scale. The prognostic ability of the original and three modified BCLC systems in HCC patients was compared by the Akaike information criterion (AIC). There were 60, 17, 11, 8, and 4% of patients who were classified as performance status 0, 1, 2, 3, and 4, respectively. A worse performance status significantly correlated with age, alcoholism, hypoalbuminemia, hyperbilirubinemia, renal insufficiency, hyponatremia, and prothrombin time prolongation (all P < 0.001). Larger tumor burden, poorer residual liver function, more frequent vascular invasion, and diabetes mellitus were also observed in patients with worse performance status (all P < 0.001). Patients with poorer performance status more often received best supportive care (P < 0.001). In the Cox proportional hazards model, performance status was an independent prognostic predictor and the long-term survival tended to be worse in patients with progressively poor performance status (all P < 0.05). Reassigning patients with performance status 0 or 1 to stage B provided the lowest AIC among the four BCLC-based staging systems.
Performance status is strongly associated with both tumoral and cirrhotic factors and accurately predicts long-term survival in HCC patients. Modification of the BCLC system based on performance status may further enhance its prognostic ability in patients with early to advanced cancer stage. (HEPATOLOGY 2013)