Comparison of Three Staging Systems in Prediction of Survival of Patients with Advanced Hepatocellular Carcinoma after Hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XULei-bo , WANGJie ,  LIUChao

Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China;

Corresponding author：

LIUChao, Email: mdliuchao@hotmail.com

Keywords：

Hepatocellular carcinoma; Hepatectomy; Staging; Survival

DOI：

10.7507/1007-9424.20140032

Video：

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Objective To compare three staging systems for predicting the prognosis of patients with advanced hepatocellular carcinoma (HCC) after hepatectomy. Methods The clinical data of advanced HCC patients who underwent hepatectomy from January 2004 to December 2008 in this hospital were retrospectively analyzed.Tumor stage was evaluated following the Chinese staging system, tumor node metastasis (TNM) staging system, and cancer of the liver Italian program (CLIP) scoring system, respectively.Survival curves for the HCC patients were plotted using the Kaplan-Meier method and difference was compared by the log-rank test.The accuracy of each staging system for predicting survival of HCC patients was evaluated by calculating the area under curve of the receiver operating characteristic. Results Fifty-five patients were included in this study, including 48 males and 7 females.The median age was 47 years and the median overall survival was 7 months.The clinical staging of HCC patients was 25 cases ofⅡB and 30 cases ofⅢA using Chinese staging system; 39 cases ofⅢA, 5 cases ofⅢB, 7 cases ofⅣA, and 4 cases ofⅣB using TNM staging system.The score of 0-1 was 16 cases, the score of 2-3 was 26 cases, and the score≥4 was 13 cases using CLIP scoring system.Log-rank test showed that the cumulative survival rate had a significant difference for the HCC patients betweenⅡB andⅢA of Chinese staging system (P < 0.05) and amongⅢA toⅣB of TNM staging system (P < 0.05).However, there was no significant difference in the HCC patients among score of 0-4 of CLIP scoring system (P > 0.05).The accuracy of Chinese staging system was higher than that of the TNM staging system and CLIP scoring system for predicting the survival rate of HCC patients (P > 0.05). Conclusion According to this limited preliminary data, Chinese staging system for strati-fying and predicting the prognosis of advanced HCC patients after hepatectomy is better than that of TNM staging system and CLIP scoring system.

Citation： XULei-bo, WANGJie, LIUChao. Comparison of Three Staging Systems in Prediction of Survival of Patients with Advanced Hepatocellular Carcinoma after Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(2): 138-141. doi: 10.7507/1007-9424.20140032 Copy

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6.	Edge SB, Compton CC, Fritz AG, et al.AJCC cancer staging manual[M].7th ed.New York, NY:Springer, 2010:237-246.
7.	Llovet JM, Bruix J.Prospective validation of the Cancer of the Liver Italian Program (CLIP) score:a new prognostic system for patients with cirrhosis and hepatocellular carcinoma[J].Hepatology, 2000, 32(3):679-680.
8.	Llovet JM, Brú C, Bruix J.Prognosis of hepatocellular carcinoma:the BCLC staging classification[J].Semin Liver Dis, 1999, 19(3):329-338.
9.	Kudo M, Chung H, Osaki Y.Prognostic staging system for hepatocellular carcinoma (CLIP score):its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score)[J].J Gastroenterol, 2003, 38(3):207-215.
10.	Tateishi R, Yoshida H, Shiina S, et al.Proposal of a new prognostic model for hepatocellular carcinoma:an analysis of 403 patients[J].Gut, 2005, 54(3):419-425.
11.	杨秉辉, 任正刚, 汤钊猷.关于原发性肝癌临床分期的研究和建议[J].中华肝胆外科杂志, 1999, 5(1):67-68.
12.	Yan P, Yan LN.Staging of hepatocellular carcinoma[J].Hepatobiliary Pancreat Dis Int, 2003, 2(4):491-495.
13.	Poon RT, Fan ST, Tsang FH, et al.Locoregional therapies for hepatocellular carcinoma:a critical review from the surgeon's perspective[J].Ann Surg, 2002, 235(4):466-486.
14.	Varotti G, Ramacciato G, Ercolani G, et al.Comparison between the fifth and sixth editions of the AJCC/UICC TNM staging systems for hepatocellular carcinoma:multicentric study on 393 cirrhotic resected patients[J].Eur J Surg Oncol, 2005, 31(7):760-767.
15.	Yeh CN, Chen MF, Lee WC, et al.Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis:univariate and multivariate analysis[J].J Surg Oncol, 2002, 81(4):195-202.
16.	Leung TW, Tang AM, Zee B, et al.Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system:a study based on 926 patients[J].Cancer, 2002, 94(6):1760-1769.
17.	Llovet JM, Bruix J, Fuster J, et al.Liver transplantation for small hepatocellular carcinoma:the tumor-node-metastasis classification does not have prognostic power[J].Hepatology, 1998, 27(6):1572-1577.

1. Jemal A, Siegel R, Ward E, et al.Cancer statistics, 2009[J].CA Cancer J Clin, 2009, 59(4):225-249.
2. Yuen MF, Hou JL, Chutaputti A; Asia Pacific Working Party on Prevention of Hepatocellular Carcinoma.Hepatocellular carcinoma in the Asia pacific region[J].J Gastroenterol Hepatol, 2009, 24(3):346-353.
3. El-Serag HB, Rudolph KL.Hepatocellular carcinoma:epidemio-logy and molecular carcinogenesis[J].Gastroenterology, 2007, 132(7):2557-2576.
4. Chung H, Kudo M, Takahashi S, et al.Review of current staging systems for hepatocellular carcinoma[J].Hepatol Res, 2007, 37(Suppl 2):S210-S215.
5. Okuda K, Ohtsuki T, Obata H, et al.Natural history of hepatocellular carcinoma and prognosis in relation to treatment.Study of 850 patients[J].Cancer, 1985, 56(4):918-928.
6. Edge SB, Compton CC, Fritz AG, et al.AJCC cancer staging manual[M].7th ed.New York, NY:Springer, 2010:237-246.
7. Llovet JM, Bruix J.Prospective validation of the Cancer of the Liver Italian Program (CLIP) score:a new prognostic system for patients with cirrhosis and hepatocellular carcinoma[J].Hepatology, 2000, 32(3):679-680.
8. Llovet JM, Brú C, Bruix J.Prognosis of hepatocellular carcinoma:the BCLC staging classification[J].Semin Liver Dis, 1999, 19(3):329-338.
9. Kudo M, Chung H, Osaki Y.Prognostic staging system for hepatocellular carcinoma (CLIP score):its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score)[J].J Gastroenterol, 2003, 38(3):207-215.
10. Tateishi R, Yoshida H, Shiina S, et al.Proposal of a new prognostic model for hepatocellular carcinoma:an analysis of 403 patients[J].Gut, 2005, 54(3):419-425.
11. 杨秉辉, 任正刚, 汤钊猷.关于原发性肝癌临床分期的研究和建议[J].中华肝胆外科杂志, 1999, 5(1):67-68.
12. Yan P, Yan LN.Staging of hepatocellular carcinoma[J].Hepatobiliary Pancreat Dis Int, 2003, 2(4):491-495.
13. Poon RT, Fan ST, Tsang FH, et al.Locoregional therapies for hepatocellular carcinoma:a critical review from the surgeon's perspective[J].Ann Surg, 2002, 235(4):466-486.
14. Varotti G, Ramacciato G, Ercolani G, et al.Comparison between the fifth and sixth editions of the AJCC/UICC TNM staging systems for hepatocellular carcinoma:multicentric study on 393 cirrhotic resected patients[J].Eur J Surg Oncol, 2005, 31(7):760-767.
15. Yeh CN, Chen MF, Lee WC, et al.Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis:univariate and multivariate analysis[J].J Surg Oncol, 2002, 81(4):195-202.
16. Leung TW, Tang AM, Zee B, et al.Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system:a study based on 926 patients[J].Cancer, 2002, 94(6):1760-1769.
17. Llovet JM, Bruix J, Fuster J, et al.Liver transplantation for small hepatocellular carcinoma:the tumor-node-metastasis classification does not have prognostic power[J].Hepatology, 1998, 27(6):1572-1577.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Three Staging Systems in Prediction of Survival of Patients with Advanced Hepatocellular Carcinoma after Hepatectomy

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