Prognosis Evaluation in Patients with Hepatocellular Carcinoma after Hepatectomy: Comparison of BCLC, TNM and Hangzhou Criteria Staging Systems

Abstract

PurposeThis study is to evaluate the Hangzhou criteria (HC) for patients with HCC undergoing surgical resection and to identify whether this staging system is superior to other staging systems in predicting the survival of resectable HCC.Method774 HCC patients underwent surgical resection between 2007 and 2009 in West China Hospital were enrolled retrospectively. Predictors of survival were identified using the Kaplan–Meier method and the Cox model. The disease state was staged by the HC, as well as by the TNM and BCLC staging 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).ResultsSerum AFP level (P = 0.02), tumor size (P<0.001), tumor number (P<0.001), portal vein invasion (P<0.001), hepatic vein invasion (P<0.001), tumor differentiation (P<0.001), and distant organ (P = 0.016) and lymph node metastasis (P<0.001) were identified as independent risk factors of survival after resection by multivariate analysis. The comparison of the different staging system results showed that BCLC had the best homogeneity (likelihood ratio χ2 test 151.119, P<0.001), the TNM system had the best monotonicity of gradients (linear trend χ2 test 137.523, P<0.001), and discriminatory ability was the highest for the BCLC (the AUCs for 1-year mortality were 0.759) and TNM staging systems (the AUCs for 3-, and 5-year mortality were 0.738 and 0.731, respectively). However, based on the c-index and AIC, the HC was the most informative staging system in predicting survival (c-index 0.6866, AIC 5924.4729).ConclusionsThe HC can provide important prognostic information after surgery. The HC were shown to be a promising survival predictor in a Chinese cohort of patients with resectable HCC.

Validation of models in patients with hepatocellular carcinoma

“…Its classification according to the segments of liver may be more useful in prognostic analysis. Nevertheless, the significance of these tumor parameters in our study was not surprising and is supported by many other studies showing their predictive importance [21][22][23][24]. Interestingly, two laboratory parameters were considered to be important for prognostification.…”

<p>High Inflammatory Factor Grading Predicts Poor Disease-Free Survival in AJCC Stage I-II Hepatocellular Carcinoma Patients After R0 Resection</p>

“…The clinical grading systems for HCC prognosis include Barcelona clinic liver cancer (BCLC) staging, 11 Okuda staging, 12 tumor-node-metastasis (TNM) staging, 13 and albumin-bilirubin (ALBI) grading, 14 and they consider factors such as tumor size, number of lesions, vascular invasion, extrahepatic metastases, and common clinical and pathological factors such as Child-Pugh classification. However, none of these grading systems take into account the inflammatory status of the tumor microenvironment.…”

Overexpression of CD147 is associated with poor prognosis, tumor cell migration and ERK signaling pathway activation in hepatocellular carcinoma

“…Based on the results of CD147 detection and long-term follow-up, logistic regression analyses were performed, which separately revealed a 200% increased risk of death in HCC patients with high serum levels (≥21.0 ng/ml) and positive tissue expression of CD147. Multiple clinical pathological indicators, such as TNM stage, tumor size and serum α-fetoprotein (AFP) levels, were also potential recurrent and prognostic factors (28)(29)(30), and they may not be evenly distributed between surviving and dead patients. Therefore, multivariate logistic regression analyses were well adjusted for these potential confounders, revealing that poor prognosis during the follow-up period was still associated with positive tissue expression of CD147, but the association between increased risk of mortality and high serum CD147 levels lost its significance.…”