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Development of a prognostic scoring system for resectable hepatocellular carcinoma

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To develop a prognostic scoring system for overall survival (OS) of patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC).

Methods: Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) surgical criteria by means of Harrell’s C statistics.

Results: A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training (P < 0.0001) and the validation set (P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/AASLD guidelines (77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell’s C statistics revealed no significant difference in predictive power between the two systems (-0.00999, P = 0.667).

Conclusion: This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/AASLD criteria with no harm on survival.

No MeSH data available.


Scoring system according to risk estimates of death at 5-yr. Patients are considered at low risk with a score = 0-1 (risk estimates: 0.347-0.459), intermediate risk with a score = 2 (risk estimate: 0.59), and high risk with a score = 3-9 (risk estimates: 0.723-1).
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Figure 1: Scoring system according to risk estimates of death at 5-yr. Patients are considered at low risk with a score = 0-1 (risk estimates: 0.347-0.459), intermediate risk with a score = 2 (risk estimate: 0.59), and high risk with a score = 3-9 (risk estimates: 0.723-1).

Mentions: The total score ranged between 0 and 9. The risk estimates were calculated for each score using the Cox proportional hazards model, and three risk stages were defined according to changes in the risk estimates for each point increase (Figure 1): Low risk: 0 to 1 points Intermediate risk: 2 points; High risk: 3 to 9 points.


Development of a prognostic scoring system for resectable hepatocellular carcinoma
Scoring system according to risk estimates of death at 5-yr. Patients are considered at low risk with a score = 0-1 (risk estimates: 0.347-0.459), intermediate risk with a score = 2 (risk estimate: 0.59), and high risk with a score = 3-9 (risk estimates: 0.723-1).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037088&req=5

Figure 1: Scoring system according to risk estimates of death at 5-yr. Patients are considered at low risk with a score = 0-1 (risk estimates: 0.347-0.459), intermediate risk with a score = 2 (risk estimate: 0.59), and high risk with a score = 3-9 (risk estimates: 0.723-1).
Mentions: The total score ranged between 0 and 9. The risk estimates were calculated for each score using the Cox proportional hazards model, and three risk stages were defined according to changes in the risk estimates for each point increase (Figure 1): Low risk: 0 to 1 points Intermediate risk: 2 points; High risk: 3 to 9 points.

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To develop a prognostic scoring system for overall survival (OS) of patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC).

Methods: Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) surgical criteria by means of Harrell’s C statistics.

Results: A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training (P < 0.0001) and the validation set (P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/AASLD guidelines (77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell’s C statistics revealed no significant difference in predictive power between the two systems (-0.00999, P = 0.667).

Conclusion: This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/AASLD criteria with no harm on survival.

No MeSH data available.