Evaluation of the prognostic powers of various tumor status grading scales in patients with hepatocellular carcinoma
Article first published online: 10 JUL 2008
© 2008 The Authors. Journal compilation © 2008 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 23, Issue 8pt1, pages 1267–1275, August 2008
How to Cite
Seo, Y. S., Kim, Y. J., Um, S. H., Yoo, H., Lee, J. W., Kim, Y. S., Jeen, Y. T., Chun, H. J., Kim, C. D. and Ryu, H. S. (2008), Evaluation of the prognostic powers of various tumor status grading scales in patients with hepatocellular carcinoma. Journal of Gastroenterology and Hepatology, 23: 1267–1275. doi: 10.1111/j.1440-1746.2008.05480.x
- Issue published online: 31 JUL 2008
- Article first published online: 10 JUL 2008
- Accepted for publication 24 February 2008.
- hepatocellular carcinoma;
- prognostic power;
- staging system
Backgrounds and Aim: Several tumor status grading scales are available for patients with hepatocellular carcinoma (HCC), which include several tumor-node-metastasis (TNM) systems and clinical staging systems, such as Cancer of the Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC). This study was performed to analyze the prognostic powers of these tumor status grading systems in HCC.
Methods: A retrospective cohort of 499 consecutive patients with HCC was included. The tumor statuses of all patients were classified according to several TNM systems (sixth version of the American Joint Committee on Cancer, fourth version of the Liver Cancer Study Group of Japan [LCSGJ], and the United Network for Organ Sharing UNOS system) and according to the tumor status grading scales of the BCLC (TBCLC) and CLIP (TCLIP) systems. Prognostic powers were quantified using a linear trend χ2-test, c-index, and the likelihood ratio (LHR) χ2-test, and correlated using Cox's regression model adjusted using the Akaike information criterion (AIC).
Results: Of the TNM systems, the fourth LCSGJ system had the highest prognostic power (LHR χ2 = 7.20, AIC = 4803.02). However, when TBCLC and TCLIP were included in the analysis, TCLIP showed the best predictive power (LHR χ2 = 29.52, AIC = 4799.82).
Conclusion: TCLIP had best predictive power in HCC patients of the various tumor staging systems examined. To improve prognostic power, factors other than tumor burden, such as tumor behavior, should be included in the tumor status grading system for HCC.