The 7th/8th American Joint Committee on Cancer and the Modified Union for International Cancer Control Staging System for Hepatocellular Carcinoma

Abstract

PurposeAlthough many staging systems have been proposed for hepatocellular carcinoma (HCC), there is no globally accepted system due to the extreme heterogeneity of the disease. We aimed to compare the results of the 7th/8th American Joint Committee on Cancer (AJCC) and the modified Union for International Cancer Control (mUICC) staging systems in patients with HCC.Materials and MethodsWe collected data from 792 patients who underwent hepatic resection at our center. The Kaplan-Meier method was used to determine disease-free survival and overall survival. To evaluate homogeneity, ‘-2 log likelihood’ was calculated using Cox proportional hazards regression. To measure discriminatory ability, the linear trend chi method and the Cochran-Armitage test for trend were used. The ability to accurately predict survival was verified by cross-validation analysis.ResultsKaplan-Meier curves for disease-free survival and overall survival showed mUICC to be superior to the 7th/8th AJCC. The homogeneity test indicated that mUICC was the best for both disease-free survival and overall survival. In the discriminatory ability test, the chi-square value of mUICC was the best for disease-free survival, while the 7th AJCC had the best value for overall survival. In the cross-validation analysis, all three staging systems had significant predictive power.ConclusionmUICC seemed to be superior to the 7th/8th AJCC after analyzing the data of our surgical patients, although the geographic heterogeneity of HCC might result in differences between the staging systems. We believe that, while the three staging systems allow for the clear stratification of patients into prognostic groups, mUICC may be more appropriate in HCC.

Survival Predictability Between the American Joint Committee on Cancer 8th Edition Staging System and the Barcelona Clinic Liver Cancer Classification in Patients with Hepatocellular Carcinoma

“…A similar study using SEER database (1998–2013), which comprised 8,918 patients (63% resected or 37% transplanted), reported that the c‐index for the AJCC 8th edition staging system was 0.60, which was parallel to that for the 7th edition (0.59) [23]. Another study using 792 Korean patients with HCC (underwent liver resection or liver transplantation) reported comparable results showing small improvement of the 8th edition of the TNM system in predicting overall and cancer‐specific survivals compared with the 7th edition [21].…”

“…The AIC method gives directions to select the best model from a set of models by computer calculations as follows: AIC = 2 k − 2 ln( L ), where k refers to the number of parameters and L refers to the maximized value of the likelihood function for the estimated model [16, 20]. The homogeneity (differences in outcomes among patients of the same stage) was assessed by “−2 log‐likelihood,” which could be calculated by Cox proportional hazards models [21]. Because the smallest value of AIC indicates the best model fit, we report ΔAIC (distance between the best model and each other model).…”

Exosomal microRNA‐4661‐5p–based serum panel as a potential diagnostic biomarker for early‐stage hepatocellular carcinoma

“…Clinical data collected pertained to age, gender, etiology of liver disease, AST level, ALT level, platelet count, serum AFP level, serum albumin level, serum bilirubin level, and international normalized ratio (INR). Tumor size, tumor numbers, presence of vascular invasion, and tumor stage according to the modified Union for International Cancer Control (mUICC) staging system were investigated in HCC patients 21 . Early‐stage HCC was defined as single tumor <2 cm in diameter, which was equivalent to mUICC stage I. High‐risk condition of developing HCC was defined as chronic hepatitis or LC.…”

Overall survival among patients who undergo resection does not differ significantly between T1a and T1b hepatocellular carcinoma based on the 8th American Joint Commission on Cancer

“…Although previous studies have evaluated the performance of the AJCC 8th edition among patients who undergo surgery to treat HCC, controversial results have been reported [7][8][9][10]. Previous singleinstitutional studies that enrolled patients with HCC who underwent LR in South Korea showed no signi cant difference in OS between patients with T1a and T1b tumors [8,9].…”