Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort

Abstract

Currently there is no consensus which staging system is best in predicting the survival of patients with hepatocellular carcinoma (HCC). The aims of this study were to identify independent predictors of survival and to compare 7 available prognostic staging systems in patients with HCC. A total of 239 consecutive patients with cirrhosis and HCC seen between January 1, 2000, and December 31, 2003, were included. Demographic, laboratory, and tumor characteristics and performance status were determined at diagnosis and before therapy. Predictors of survival were identified using the Kaplan-Meir test and the Cox model. Sixty-two percent of patients had hepatitis C, 56% had more than 1 tumor nodule, 24% had portal vein thrombosis, and 29% did not receive any cancer treatment. At the time of censorship, 153 (63%) patients had died. The 1-and 3-year survival of the entire cohort was 58% and 29%, respectively. The independent predictors of survival were performance status (P < .0001), MELD score greater than 10 (P ‫؍‬ .001), portal vein thrombosis (P ‫؍‬ .0001), and tumor diameter greater than 4 cm (P ‫؍‬ .001). Treatment of HCC was related to overall survival. The Barcelona Clinic Liver Cancer (BCLC) staging system had the best independent predictive power for survival when compared with the other 6 prognostic systems. In conclusion, performance status, tumor extent, liver function, and treatment were independent predictors of survival mostly in patients with cirrhosis and HCC. The BCLC staging system includes aspects of all of these elements and provided the best prognostic stratification for our cohort of patients with HCC. ( H epatocellular carcinoma (HCC) is the fifth most common tumor worldwide. In the United States, the incidence of HCC has been rising, 1 and it is the tumor with the largest increase in incidence over the last 12 years. 2 Furthermore, the overall survival of patients with HCC has not improved over the last 20 years, with the incidence rate almost equal to the death rate. 3 It is projected that the increase in incidence of HCC will continue over the next 20 years in the United States. 4 Therefore, it is important to understand the factors that predict survival of patients with HCC.

Selecting an optimal staging system for hepatocellular carcinoma

“…Previous studies reported that the BCLC staging system was the best model for cancer staging. 4,7,8 In contrast, other studies found that the JIS scoring system was a better model in comparison with the CLIP and BCLC staging systems. 12,13,30 Several factors may contribute to these discrepancies.…”

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

“…[22][23][24][25] In addition to these prospective validations, several studies have demonstrated the ability of the model. 26,27 It has been recently endorsed by numerous groups 1,21,28 and is included in the guidelines for the management of HCC from the American Association for the Study of Liver Diseases. 29 Other staging systems such as the CLIP system have also been externally validated.…”

Drug therapy: Sorafenib

“…Several staging systems have been put forward without a consensus. [4][5][6] The commonly accepted International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (or TNM) used in other solid tumors is of limited value in HCC as it does not take into account the competing risk of liver dysfunction which certainly plays a role in outcomes and treatment decisions. Most recently, the Barcelona Clinic Liver Cancer Staging (BCLCS) system has been adopted in many prospective studies in HCC for patient selection and provides a reasonable framework for clinical decision-making (Fig.…”