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A new Child-Turcotte-Pugh class 0 for patients with hepatocellular carcinoma: determinants, prognostic impact and ability to improve the current staging systems.

Lee YH, Hsu CY, Chu CW, Liu PH, Hsia CY, Huang YH, Su CW, Chiou YY, Lin HC, Huo TI - PLoS ONE (2014)

Bottom Line: The prognostic ability was compared by the Akaike information criterion (AIC).In the Cox proportional hazards model, the adjusted hazard ratios for CTP class A, B and C were 1.739, 3.120 and 5.107, respectively, compared to class 0 (all p<0.001).The proposal of CTP class 0 independently predicted better survival in HCC patients.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine, Yuanshan Branch of Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT

Background/aim: Majority of patients with hepatocellular carcinoma (HCC) belonged to Child-Turcotte-Pugh (CTP) class A. We aimed to identify a new class of patients with very well-preserved liver function and analyze its impact on outcome prediction, tumor staging and treatment allocation.

Methods: A total of 2654 HCC patients were retrospectively analyzed. The prognostic ability was compared by the Akaike information criterion (AIC).

Results: The CTP class 0 was defined by fulfilling all criteria of albumin ≧4 g/dL, bilirubin ≦0.8 mg/dL, prothrombin time prolongation <0 seconds, no ascites and encephalopathy. A total of 23% of patients of CTP class A were reclassified as CTP class 0. Patients with CTP class 0 had a higher serum sodium level, lower serum creatinine, alanine aminotransferase, α-fetoprotein levels, shorter prothrombin time, better general well-being, smaller tumor burden with more solitary nodules, lower rates of vascular invasion, ascites formation, hepatic encephalopathy, more frequently treated with curative interventions and better Barcelona Clinic Liver Cancer (BCLC) stages (all p<0.001). In the Cox proportional hazards model, the adjusted hazard ratios for CTP class A, B and C were 1.739, 3.120 and 5.107, respectively, compared to class 0 (all p<0.001). Reassigning patients with CTP class 0, A, B, B and C to stage 0, A, B, C and D, respectively, provided the lowest AIC score among all BCLC-based models.

Conclusions: The proposal of CTP class 0 independently predicted better survival in HCC patients. Modification of tumor staging systems according to the modified CTP classification further enhances their prognostic ability.

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Related in: MedlinePlus

Comparison of survival distributions between patients of different CTP classifications.Patients with the new CTP class 0 were associated with a better long-term survival (panel B; p<0.001). Pairwise comparison between each CTP and modified CTP classes showed significant survival differences (panel A p<0.001).
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pone-0099115-g001: Comparison of survival distributions between patients of different CTP classifications.Patients with the new CTP class 0 were associated with a better long-term survival (panel B; p<0.001). Pairwise comparison between each CTP and modified CTP classes showed significant survival differences (panel A p<0.001).

Mentions: During a median follow up period of 18 [range 0.5–129, interquartile range (IQR) 40] months, the cumulative 3- and 5- year survival of patients with original CTP class A, B and C were 70% and 50%, 36% and 26% and 17% and 15%, respectively (p<0.001; Fig. 1A).


A new Child-Turcotte-Pugh class 0 for patients with hepatocellular carcinoma: determinants, prognostic impact and ability to improve the current staging systems.

Lee YH, Hsu CY, Chu CW, Liu PH, Hsia CY, Huang YH, Su CW, Chiou YY, Lin HC, Huo TI - PLoS ONE (2014)

Comparison of survival distributions between patients of different CTP classifications.Patients with the new CTP class 0 were associated with a better long-term survival (panel B; p<0.001). Pairwise comparison between each CTP and modified CTP classes showed significant survival differences (panel A p<0.001).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048310&req=5

pone-0099115-g001: Comparison of survival distributions between patients of different CTP classifications.Patients with the new CTP class 0 were associated with a better long-term survival (panel B; p<0.001). Pairwise comparison between each CTP and modified CTP classes showed significant survival differences (panel A p<0.001).
Mentions: During a median follow up period of 18 [range 0.5–129, interquartile range (IQR) 40] months, the cumulative 3- and 5- year survival of patients with original CTP class A, B and C were 70% and 50%, 36% and 26% and 17% and 15%, respectively (p<0.001; Fig. 1A).

Bottom Line: The prognostic ability was compared by the Akaike information criterion (AIC).In the Cox proportional hazards model, the adjusted hazard ratios for CTP class A, B and C were 1.739, 3.120 and 5.107, respectively, compared to class 0 (all p<0.001).The proposal of CTP class 0 independently predicted better survival in HCC patients.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine, Yuanshan Branch of Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT

Background/aim: Majority of patients with hepatocellular carcinoma (HCC) belonged to Child-Turcotte-Pugh (CTP) class A. We aimed to identify a new class of patients with very well-preserved liver function and analyze its impact on outcome prediction, tumor staging and treatment allocation.

Methods: A total of 2654 HCC patients were retrospectively analyzed. The prognostic ability was compared by the Akaike information criterion (AIC).

Results: The CTP class 0 was defined by fulfilling all criteria of albumin ≧4 g/dL, bilirubin ≦0.8 mg/dL, prothrombin time prolongation <0 seconds, no ascites and encephalopathy. A total of 23% of patients of CTP class A were reclassified as CTP class 0. Patients with CTP class 0 had a higher serum sodium level, lower serum creatinine, alanine aminotransferase, α-fetoprotein levels, shorter prothrombin time, better general well-being, smaller tumor burden with more solitary nodules, lower rates of vascular invasion, ascites formation, hepatic encephalopathy, more frequently treated with curative interventions and better Barcelona Clinic Liver Cancer (BCLC) stages (all p<0.001). In the Cox proportional hazards model, the adjusted hazard ratios for CTP class A, B and C were 1.739, 3.120 and 5.107, respectively, compared to class 0 (all p<0.001). Reassigning patients with CTP class 0, A, B, B and C to stage 0, A, B, C and D, respectively, provided the lowest AIC score among all BCLC-based models.

Conclusions: The proposal of CTP class 0 independently predicted better survival in HCC patients. Modification of tumor staging systems according to the modified CTP classification further enhances their prognostic ability.

Show MeSH
Related in: MedlinePlus