Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho, Yun Ku; Chung, Jin Wook; Kim, Tae Yong; Ahn, Yong Sik; Kim, Mi Young; Park, Yoon Ok; Kim, Wantae; Byun, Junyoung

doi:10.1002/cncr.23185

Cited by 110 publications

(74 citation statements)

References 33 publications

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“…A previous study reported that the BCLC classification system shows a superior discriminatory power in their HCC patients who underwent RFA (n=112) among seven prognostic system, however, in the present study, in patients treated with PATs, in 1-year c-index, BCLC classification system had the highest value, while in 3-and 5-year c-index, PS-JIS system had the highest value (29). Likewise, Cho et al (18) demonstrated that CLIP system provided the best prognostic stratification for HCC patients who underwent transarterial chemoembolization (n=131), whereas in our analysis, in patients treated with TATs, in 1-, 3-and 5-year c-index, PS-JIS system had the highest value. As well as in patients treated with SR, these discrepancies can probably be explained in part by the difference of the baseline patient characteristics in the investigated populations.…”

Section: Discussioncontrasting

confidence: 63%

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Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis

Nishikawa

Kita

Kimura

et al. 2015

International Journal of Oncology

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Abstract. The present study examined the prognostic ability of our proposed performance status combined Japan Integrated Staging (PS-JIS) system in hepatocellular carcinoma (HCC) patients with liver cirrhosis (LC) comparing with other four prognostic systems including original JIS system, the Barcelona Clinic Liver Cancer classification system, TNM classification system and the Cancer of the Liver Italian Program (CLIP) scoring system. A total of 1,170 HCC patients complicated with LC were analysed. The disease was staged for all analysed patients by means of the five staging systems. The cumulative overall survival (OS) rate was calculated by Kaplan-Meier method and tested by log-rank test. We also examined prognostic factors associated with OS using univariate and multivariate analyses and compared the prognostic ability in each prognostic system using concordance index (c-index) at 1-, 3-and 5-year time-points. Overall significance in each prognostic system was P<0.001. In the multivariate analyses, tumor number, Child-Pugh classification, PS, initial treatment modality and several laboratory parameters were significant independent predictors linked to OS. For all cases, in each time-point, the c-index of PS-JIS system was the highest among five staging systems (0.847, 0.816 and 0.808, respectively), indicating that PS-JIS system has the best predictability among these staging systems. According to subgroup analyses stratified by initial treatment modality, in patients treated with surgical resection (n=205), CLIP scoring system had the highest c-index at every timepoint, whereas in patients treated with percutaneous ablative therapies (n=632) at 3-and 5-year time-point and in those with transcatheter arterial therapies (n=281) at every time-point, the c-index of PS-JIS system was the highest. In conclusion, the proposed PS-JIS score can be a useful prognostic system for HCC patients complicated with liver cirrhosis. IntroductionClinical staging for malignancies provides a useful guidance for predicting survival and for deciding optimal treatment strategies (1). Design of a cancer staging system depends on the identification of individual prognostic factors that can predict survival of cancer patients (1-3). Unlike other solid tumors, the prognosis and treatment strategies for subjects with hepatocellular carcinoma (HCC) depend not only on the tumor characteristics but also on the degree of liver function (2-9). Based on the identification of relevant predictors for both the tumor burden and liver functional reserve, several staging systems for HCC including both aspects had been proposed.In 1998, the Cancer of the Liver Italian Program (CLIP) proposed a new scoring system (CLIP scoring system) that accounts for both tumor characteristics and liver function relevant to prognostic evaluation for HCC patients. This score consisted of four variables of Child-Pugh classification, α-fetoprotein (AFP) value, tumor morphology and portal vein invasion and its prognostic ability has been validated in several countries...

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Section: Discussioncontrasting

confidence: 63%

“…Currently, there are two modified JIS system: biomarker combined JIS system and the model for end stage liver disease-based JIS system (18,19). In the present study, on the basis of above, we herein propose a PS combined JIS (PS-JIS) system for HCC patients with LC.…”

Section: Introductionmentioning

confidence: 97%

Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis

Nishikawa

Kita

Kimura

et al. 2015

International Journal of Oncology

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“…This result was consistently supported by a recent study from Korea, which reported that the CLIP score was the best model among the 7 systems for outcome prediction in HCC patients undergoing palliative TACE. 35 Altogether, these lines of evidence indicate that the CLIP staging system is a reliable model that can best differentiate long-term survival and can fit in different patient populations characterized by favorable and unfavorable outcomes.…”

Section: Discussionmentioning

confidence: 97%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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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 longterm 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.

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“…Hypoalbuminemia is predictive of increased 90-day mortality and poor overall survival after radical cystectomy in patients with bladder cancer (27). In patients with hepatocellular carcinoma, hypoalbuminemia is an independent poor prognostic factor (28). Separate studies reported that preoperative hypoalbuminemia is associated with earlier tumor recurrence and death following potentially curative resection for colon and rectal cancer (24,29).…”

Section: Discussionmentioning

confidence: 99%

Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma

Kim

Choi

et al. 2014

Int. braz j urol.

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ARTICLE INFO ______________________________________________________________ ______________________Purpose: The study evaluated whether preoperative measures of the C-reactive protein--based systemic inflammatory response may predict cancer survival independent of tumor stage in patients with upper urinary tract urothelial carcinoma (UTUC). Materials and Methods:Between September 1999 and October 2010, 181 patients submitted to radical nephroureterectomy were available for evaluation. Multivariate survival analyses were performed using Cox's proportional hazards model and the coefficient for each factor was divided by the highest coefficient, multiplied by 4, and rounded to the nearest integer.Results: Multivariate analyses showed that tumor location, pathologic T stage, lymphovascular invasion, margin status, and albumin level were independent contributors. The bootstrap-corrected C statistics of the model were 0.813 for disease-specific survival and 0.755 for overall survival, respectively. For time to disease-specific and overall mortality for patients, integrated area under the curve values were 0.792 and 0.739, respectively. When patients were clustered into three groups according to their model--predicted survival, the 5-year disease-specific survival in the low-, intermediate-and high-risk group was 95.4%, 76.2%, and 36.9%, respectively (p<0.001), and were 87.8%, 54.4%, and 31.8%, respectively, for overall survival (p<0.001). Decision curve analysis revealed that the use of model was associated with net benefit gains relative to the treat-all strategy. Conclusions: Pretreatment albumin is a simple biomarker based on routinely available well-standardized measures, and is not an expensive and time-consuming process. Hypoalbuminemia is an independent marker of poor prognosis in patients with upper urinary tract urothelial carcinoma.

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Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cited by 110 publications

References 33 publications

Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis

Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis

Selecting an optimal staging system for hepatocellular carcinoma

Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma

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