Selecting an Optimal Staging System for Intermediate-Stage Hepatocellular Carcinoma: Comparison of 9 Currently Used Prognostic Models.
hepatic resection
hepatocellular carcinoma
intermediate-stage
overall survival
prognosis
staging system
transarterial chemoembolization
Journal
Journal of hepatocellular carcinoma
ISSN: 2253-5969
Titre abrégé: J Hepatocell Carcinoma
Pays: New Zealand
ID NLM: 101674775
Informations de publication
Date de publication:
2021
2021
Historique:
received:
10
02
2021
accepted:
01
04
2021
entrez:
28
4
2021
pubmed:
29
4
2021
medline:
29
4
2021
Statut:
epublish
Résumé
It remains unknown which staging system is best in predicting the survival of patients with intermediate stage hepatocellular carcinoma (HCC). We aimed to investigate the performance of nine currently used HCC staging systems. Between 2005 and 2014, a large cohort of 880 consecutive patients with intermediate stage HCC and sufficient data for utilization in all staging systems were enrolled. The prognostic performance of each staging system was compared. Independent prognostic variables were also identified. Multivariate analysis revealed that alkaline phosphatase (ALP), aspartate aminotransferase (AST), etiology, alpha-fetoprotein (AFP), Child-Pugh stage, tumor size, and tumor number were independent prognostic factors for survival. In the entire cohort, the Hong Kong Liver Cancer (HKLC) staging system was associated with the highest Harrell's c-index and lowest Akaike information criterion value in comparison with other systems. In subgroup analysis according to treatment strategy, the HKLC staging system remained the best prognostic model in patients undergoing hepatic resection (n=222) or transarterial chemoembolization (n=658). Additional prognostic factors of AST, ALP, etiology, and AFP improved the discriminatory ability of HKLC. The HKLC staging system is stable and consistently the best prognostic model in all patients with intermediate-stage HCC and in patients subjected to different treatment strategies. Selecting an optimal staging system is helpful in improving the design of future clinical trials in intermediate stage HCC.
Identifiants
pubmed: 33907695
doi: 10.2147/JHC.S305581
pii: 305581
pmc: PMC8064614
doi:
Types de publication
Journal Article
Langues
eng
Pagination
253-261Informations de copyright
© 2021 Zhang et al.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
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