Comparing Staging Systems for Predicting Prognosis and Survival in Patients with Hepatocellular Carcinoma in Egypt

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2014 Mar 8

PMID 24603710

Citations 35

Authors

Asmaa Ibrahim Gomaa

Mohamed Saad Hashim

Imam Waked

Affiliations

Soon will be listed here.

Abstract

Introduction: Several hepatocellular carcinoma (HCC) staging systems are available. Although the European Association for Study of Liver Diseases (EASL) and American Association for the Study of Liver Diseases (AASLD) recommended the use of Barcelona Clinic Liver Cancer (BCLC), many studies in different populations revealed heterogeneous results. The aim of this study was to compare different staging systems for predicting prognosis and survival, and for stratifying HCC patients for treatment at a national referral centre for liver disease in Egypt.

Methods: 2000 Patients were included in this study. Baseline demographic, clinical, laboratory, and radiological data were determined at diagnosis. Patients were stratified using the Okuda, BCLC, Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS). Patients' survival in different stages within each staging system and the validity of the system in predicting survival were compared.

Results: The overall survival was 15 months. The 1-, 2-, 3- and 4-year survival of the entire cohort was 56%, 34%, 25% and 15% respectively. The presence of ascites, multiple focal lesions, large tumour size >5 cm, portal vein thrombosis, extra-hepatic spread, AFP≥200 ng/ml and poor Child score were independent predictors of survival (p<0.001). All staging systems were significant in determining overall survival in univariate and multivariate analyses. BCLC was the most predictive staging system for the whole cohort (p<0.001). Among the subgroup of patients offered potentially curative therapy, BCLC was the most informative system in predicting patient survival (p<0.001). For patients with advanced HCC not amenable for specific therapy, CLIP was the best staging system for predicting prognosis (p<0.001).

Conclusion: BCLC staging system provided the best prognostic stratification for HCC patients. However, CLIP score has the highest stratification ability in patients with advanced HCC highlighting the importance of including AFP in best staging system.

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References

Ueno S, Tanabe G, Nuruki K, Hamanoue M, Komorizono Y, Oketani M . Prognostic performance of the new classification of primary liver cancer of Japan (4th edition) for patients with hepatocellular carcinoma: a validation analysis. Hepatol Res. 2002; 24(4):395-403. DOI: 10.1016/s1386-6346(02)00144-4. View

Levy I, Sherman M . Staging of hepatocellular carcinoma: assessment of the CLIP, Okuda, and Child-Pugh staging systems in a cohort of 257 patients in Toronto. Gut. 2002; 50(6):881-5. PMC: 1773247. DOI: 10.1136/gut.50.6.881. View

Yen Y, Changchien C, Wang J, Kee K, Hung C, Hu T . A modified TNM-based Japan Integrated Score combined with AFP level may serve as a better staging system for early-stage predominant hepatocellular carcinoma patients. Dig Liver Dis. 2009; 41(6):431-41. DOI: 10.1016/j.dld.2008.11.008. View

Xu H, Lu M, Xie X, Yin X, Kuang M, Chen J . Prognostic factors for long-term outcome after percutaneous thermal ablation for hepatocellular carcinoma: a survival analysis of 137 consecutive patients. Clin Radiol. 2005; 60(9):1018-25. DOI: 10.1016/j.crad.2005.04.009. View

El-Zayadi A, Badran H, Barakat E, Attia M, Shawky S, Mohamed M . Hepatocellular carcinoma in Egypt: a single center study over a decade. World J Gastroenterol. 2005; 11(33):5193-8. PMC: 4320394. DOI: 10.3748/wjg.v11.i33.5193. View

Meier V, Ramadori G . Clinical staging of hepatocellular carcinoma. Dig Dis. 2009; 27(2):131-41. DOI: 10.1159/000218345. View

Marrero J, Kudo M, Bronowicki J . The challenge of prognosis and staging for hepatocellular carcinoma. Oncologist. 2010; 15 Suppl 4:23-33. DOI: 10.1634/theoncologist.2010-S4-23. View

Cillo U, Bassanello M, Vitale A, Grigoletto F, Burra P, Fagiuoli S . The critical issue of hepatocellular carcinoma prognostic classification: which is the best tool available?. J Hepatol. 2003; 40(1):124-31. DOI: 10.1016/j.jhep.2003.09.027. View

Sakar B, Ustuner Z, Karagol H, Aksu G, Camlica H, Faruk Aykan N . Prognostic features and survival of inoperable hepatocellular carcinoma in Turkish patients with cirrhosis. Am J Clin Oncol. 2004; 27(5):489-93. DOI: 10.1097/01.coc.0000136019.94333.09. View

10.

Hanley J, McNeil B . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982; 143(1):29-36. DOI: 10.1148/radiology.143.1.7063747. View

11.

Pascual S, Zapater P, Such J, Garcia-Herola A, Sempere L, Irurzun J . Comparison of staging systems to predict survival in hepatocellular carcinoma. Liver Int. 2006; 26(6):673-9. DOI: 10.1111/j.1478-3231.2006.01282.x. View

12.

Chen C, Hu F, Huang G, Lee P, Tsang Y, Cheng A . Applicability of staging systems for patients with hepatocellular carcinoma is dependent on treatment method--analysis of 2010 Taiwanese patients. Eur J Cancer. 2009; 45(9):1630-9. DOI: 10.1016/j.ejca.2008.12.025. View

13.

Llovet J, Burroughs A, Bruix J . Hepatocellular carcinoma. Lancet. 2003; 362(9399):1907-17. DOI: 10.1016/S0140-6736(03)14964-1. View

14.

Guglielmi A, Ruzzenente A, Pachera S, Valdegamberi A, Sandri M, DOnofrio M . Comparison of seven staging systems in cirrhotic patients with hepatocellular carcinoma in a cohort of patients who underwent radiofrequency ablation with complete response. Am J Gastroenterol. 2007; 103(3):597-604. DOI: 10.1111/j.1572-0241.2007.01604.x. View

15.

Kudo M, Chung H, Osaki Y . Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol. 2003; 38(3):207-15. DOI: 10.1007/s005350300038. View

16.

Huitzil-Melendez F, Capanu M, OReilly E, Duffy A, Gansukh B, Saltz L . Advanced hepatocellular carcinoma: which staging systems best predict prognosis?. J Clin Oncol. 2010; 28(17):2889-95. PMC: 3651603. DOI: 10.1200/JCO.2009.25.9895. View

17.

Op den Winkel M, Nagel D, Sappl J, Op den Winkel P, Lamerz R, Zech C . Prognosis of patients with hepatocellular carcinoma. Validation and ranking of established staging-systems in a large western HCC-cohort. PLoS One. 2012; 7(10):e45066. PMC: 3465308. DOI: 10.1371/journal.pone.0045066. View

18.

Cillo U, Vitale A, Grigoletto F, Farinati F, Brolese A, Zanus G . Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol. 2006; 44(4):723-31. DOI: 10.1016/j.jhep.2005.12.015. View

19.

Farinati F, Rinaldi M, Gianni S, Naccarato R . How should patients with hepatocellular carcinoma be staged? Validation of a new prognostic system. Cancer. 2001; 89(11):2266-73. View

20.

Martins A, Cortez-Pinto H, Marques-Vidal P, Mendes N, Silva S, Fatela N . Treatment and prognostic factors in patients with hepatocellular carcinoma. Liver Int. 2006; 26(6):680-7. DOI: 10.1111/j.1478-3231.2006.001285.x. View