Advanced hepatocellular carcinoma: Which staging systems best predict prognosis? Journal Article


Authors: Capanu, M.; O'Reilly, E. M.; Duffy, A.; Gansukh, B.; Saltz, L.; Abou-Alfa, G. K.; Huitzil-Melendez, F. D.
Article Title: Advanced hepatocellular carcinoma: Which staging systems best predict prognosis?
Abstract: Purpose: The purpose of cancer staging systems is to accurately predict patient prognosis. The outcome of advanced hepatocellular carcinoma (HCC) depends on both the cancer stage and the extent of liver dysfunction. Many staging systems that include both aspects have been developed. It remains unknown, however, which of these systems is optimal for predicting patient survival. Patients and Methods: Patients with advanced HCC treated over a 5-year period at Memorial Sloan-Kettering Cancer Center were identified from an electronic medical record database. Patients with sufficient data for utilization in all staging systems were included. TNM sixth edition, Okuda, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), Japan Integrated Staging (JIS), and Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire (GETCH) systems were ranked on the basis of their accuracy at predicting survival by using concordance index (c-index). Other independent prognostic variables were also identified. Results: Overall, 187 eligible patients were identified and were staged by using the seven staging systems. CLIP, CUPI, and GETCH were the three top-ranking staging systems. BCLC and TNM sixth edition lacked any meaningful prognostic discrimination. Performance status, AST, abdominal pain, and esophageal varices improved the discriminatory ability of CLIP. Conclusion: In our selected patient population, CLIP, CUPI, and GETCH were the most informative staging systems in predicting survival in patients with advanced HCC. Prospective validation is required to determine if they can be accurately used to stratify patients in clinical trials and to direct the appropriate need for systemic therapy versus best supportive care. BCLC and TNM sixth edition were not helpful in predicting survival outcome, and their use is not supported by our data. © 2010 by American Society of Clinical Oncology.
Keywords: survival; adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; retrospective studies; major clinical study; advanced cancer; liver cell carcinoma; carcinoma, hepatocellular; liver neoplasms; cancer staging; neoplasm staging; diagnostic accuracy; pathology; retrospective study; prediction; abdominal pain; liver tumor; intermethod comparison; rating scale; multivariate analysis; barcelona clinic liver cancer; cancer of the liver italian program; chinese university prognostic index; concordance index; diagnostic test accuracy study; esophagus varices; groupe d etude et de traitement du carcinome hepatocellulaire; japan integrated staging
Journal Title: Journal of Clinical Oncology
Volume: 28
Issue: 17
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2010-06-01
Start Page: 2889
End Page: 2895
Language: English
DOI: 10.1200/jco.2009.25.9895
PUBMED: 20458042
PROVIDER: scopus
PMCID: PMC3651603
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 20 April 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Leonard B Saltz
    580 Saltz
  2. Austin Gerard Duffy
    14 Duffy
  3. Ghassan Abou-Alfa
    219 Abou-Alfa
  4. Marinela Capanu
    206 Capanu
  5. Eileen O'Reilly
    316 O'Reilly
  6. Bolorsukh Gansukh
    15 Gansukh