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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.


Kaplan-Meier survival estimates for the risk classes in the training set (A) and the test set (B).
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Figure 2: Kaplan-Meier survival estimates for the risk classes in the training set (A) and the test set (B).

Mentions: OS curves for the three prognostic stages are presented in Figure 2. In the training set, a significant difference in survival between the three stages was demonstrated (χ2 = 33.56 and P < 0.000), and this finding was confirmed in the validation set (χ2 = 23.67 and P = 0.0002). When considering the case series as a whole, 5-year, 10-year and median survival were 57.2%, 31.2% and 77.2 mo (95%CI: 67.4-87.0) respectively in the low risk category, 40.3% 22.6% and 41.7 mo (95%CI: 34.7-48.7) respectively in the intermediate category and 22.3% 13.4% and 17.4 mo (95%CI: 10.1-24.6) respectively in the high risk category (P < 0.000). Three-year, 5-year and median RFS were 46.4%, 33.8% and 31.5 mo (95%CI: 25.3-35.7) respectively in the low risk category, 40.1% 28.1% and 29.9 mo (95%CI: 25.6-34.2) respectively in the intermediate category and 34.5% 25.9% and 12.5 mo (95%CI: 2.8-22.2) respectively in the high risk category (P = 0.020). Details on sites of HCC recurrence and treatments for recurrence are shown in supplementary Table 2.


Development of a prognostic scoring system for resectable hepatocellular carcinoma
Kaplan-Meier survival estimates for the risk classes in the training set (A) and the test set (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Kaplan-Meier survival estimates for the risk classes in the training set (A) and the test set (B).
Mentions: OS curves for the three prognostic stages are presented in Figure 2. In the training set, a significant difference in survival between the three stages was demonstrated (χ2 = 33.56 and P < 0.000), and this finding was confirmed in the validation set (χ2 = 23.67 and P = 0.0002). When considering the case series as a whole, 5-year, 10-year and median survival were 57.2%, 31.2% and 77.2 mo (95%CI: 67.4-87.0) respectively in the low risk category, 40.3% 22.6% and 41.7 mo (95%CI: 34.7-48.7) respectively in the intermediate category and 22.3% 13.4% and 17.4 mo (95%CI: 10.1-24.6) respectively in the high risk category (P < 0.000). Three-year, 5-year and median RFS were 46.4%, 33.8% and 31.5 mo (95%CI: 25.3-35.7) respectively in the low risk category, 40.1% 28.1% and 29.9 mo (95%CI: 25.6-34.2) respectively in the intermediate category and 34.5% 25.9% and 12.5 mo (95%CI: 2.8-22.2) respectively in the high risk category (P = 0.020). Details on sites of HCC recurrence and treatments for recurrence are shown in supplementary Table 2.

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&rsquo;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 &lt; 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&rsquo;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.