不同肝癌分期方法对肝癌肝切除患者的预后价值评估的对比研究

目的探讨CLIP、JIS、中国分期3种肝癌分期方法对肝癌肝切除患者的预后价值。方法选取我院2013年1月至2017年10月收治的125例肝癌肝切除患者,使用CLIP、JIS、中国分期3种肝癌分期系统对患者初次诊断时进行评分,并进行随访,采用ROC曲线分析各预后评估系统对患者6个月生存率、12个月生存率的特异性和敏感度预测价值,使用Kaplan-Meier生存曲线及Log-rank检验评价3种分期系统对总体生存率的预测价值,应用似然比卡方检验(LRχ~2)值和线性趋势卡方检验(linear trendχ~2)值进行分期系统的判断力、同质性、梯度单一性对比。结果 CLIP分期、中国分期、JIS分期6个月生存率ROC曲线下面积分别为0.832、0.689、0.596,12个月生存率ROC曲线下面积分别为0.642、0.589、0.511,在预测肝癌肝切除患者6个月及12个月预后中,CLIP分期优于中国分期,中国分期优于JIS分期;JIS分期4分以上相互之间累积生存率差异无明显统计学意义(P0.05),不同中国分期、CLIP各累积生存率差异有统计学意义(P0.05);分期的判断力、同质性、梯度单一性比较,CLIP中国分期JIS。结论在上述3种分期系统中,CLIP对于肝癌肝切除患者生存率的预测能力最强,预后价值更高。     

不同分期系统对肝动脉化学治疗栓塞术治疗原发性肝癌预后评价作用的初步研究

分期是评估肿瘤的重要手段,能够指导治疗和判断预后.现今已经存在许多原发性肝癌的分期系统,但对这些分期的作用还存在很大争议.同时,肝动脉化学治疗栓塞术(transarterial chemoembolization,TACE)作为无法手术切除肝癌的主要治疗手段之一,关于各分期系统在其中应用的研究少见[1].本研究通过比较几种常用的分期系统,包括Child-Turcotte-Pugh(CTP)分级、Okuda分期、巴塞罗那临床肝癌(Barcelona clinic liver cancer,BCLC)分级、国内(CS)分期、法国(French)评分系统、意大利肝癌协作组(the cancer ofliver Italian program,CLIP)评分,探索肝癌TACE术后患者预后评价的有效分期,以期为治疗提供帮助.     

不同评分系统在原发性肝癌肝动脉化疗栓塞术预后判断中的应用

原发性肝癌治疗指南众多,其中巴塞罗那肝癌分期(BCLC)是国际上通常采用的肝癌治疗参考标准,然而只有B期符合肝动脉化疗栓塞术(TACE)的指征,限制了其临床应用。因此,近年来相继提出了评估原发性肝癌TACE治疗预后的评分系统,为原发性肝癌治疗提供重要参考。介绍了有关TACE治疗预后评分系统的应用现状,指出各评分系统的优缺点及评估效能,为肝癌治疗提供理论依据。     

肝癌分期对肝动脉化疗栓塞术后生存的预测作用

目的探索肝癌肝动脉化疗栓塞术（TACE）术后患者预后评价的有效分期。方法回顾性分析2006年9月至2009年5月间行TACE治疗的原发性肝癌患者的临床随访资料,比较CTP分级、MELD评分、Okuda分期、BCLC分级、CS分期和Tokyo评分对TACE治疗后生存情况的预测能力的差异。结果 Kaplan-Meier生存曲线及log-rank检验结果显示,Okuda分期各期别间差异均有统计学意义（ⅠvsⅡP=0.013,ⅡvsⅢP〈0.001）;BCLC分级B级与C级间差异有统计学意义（P=0.008）;CS分期Ⅱ期同Ⅲ期之间差异具有统计学意义（P=0.001）。Cox多因素回归分析得到Okuda分期（P=0.039）、BCLC分级（P=0.022）有统计学意义。BCLC分级同时具有最小的-2Ln（L）、AIC、SBC值,分别为205.419、209.419、212.586。结论 BCLC分级对TACE治疗后的生存情况具有较好的预测作用,可能有助于选择适宜行TACE治疗的患者。     

临床常用分期标准对原发性肝癌术后三年生存率的预测价值比较

目的 评价目前主要的4种肝癌分期标准CLIP评分,TNM、BCLC、Okuda分期对手术治疗后肝癌患者短期疗效的预测价值,选出不同临床阶段中的最优分期标准.方法 研究对象随机选自2003年3月到2008年7月在我院肝胆外科手术治疗的原发性肝癌患者,使用线性趋势卡方检验和似然比卡方检验评估各分期标准的同质性,使用COX比例风险模型计算了不同分期分别从模型中剔除时其相应对数似然估计值(-2 Loglikelihood)的升高大小.结果 患者1、2、3年总体生存率分别为84.7％、64.1％、42.9％,中位生存时间31个月,在4种评分标准中,CLIP评分和BCLC分期在同质性、判别力、梯度单一性和对模型预后预测价值的独立因素大小比较中要高于TNM和Okuda分期.结论 CLIP评分、BCLC分期对肝癌切除术后的预测价值优于TNM、Okuda分期.     

外科切除术与经肝动脉化疗栓塞术作为肝细胞癌首次治疗手段的预后对比:一项系统评价及荟萃分析

<正>根据巴塞罗那临床肝癌分期体系(BCLC),外科切除术和肝动脉化疗栓塞术(TACE)分别适用于BCLC A期和B期肝细胞癌(HCC)。为了比较HCC患者行外科切除术和TACE术后生存率,Qi等做了一项系统评价和荟萃分析。在Pub Med、EMBASE和Cochrane library数据库中,检索报道HCC患者接受外科切除术及TACE术后生存率的文献。风险比(HR)及95%可信区间(95%CI)用于比较总体生存趋势。比值比(OR)及95%CI用于比较1、3、5年生存率。根据BCLC分期及门静脉癌栓,进行亚组分析。根据研究质量及发表年代,进行敏感性分析。共检索到2029篇     

70例海南三亚黎族原发性肝癌患者个体化治疗远期疗效及预后的相关因素

目的:探讨三亚地区黎族原发性肝癌患者个体化综合治疗的疗效及预后的相关因素.方法:回顾性分析70例经个体化综合治疗的三亚地区黎族原发性肝癌患者的临床资料,全部原发性肝癌患者均为三亚地区黎族患者,采取以手术、介入栓塞化疗(transcatheter arterial chemoembolization,TACE)、分子靶向治疗、局部消融治疗以及中药扶正等综合治疗,观察个体化治疗后疗效及预后,分析相关因素.结果:70例患者中位生存期为9 mo.单因素分析结果显示:BCLC分期为0-B期、接受TACE术、接受手术、甲胎蛋白200 ng/mL、无合并肝硬化、Child-Pugh分级为A级、有局部消融治疗和分子靶向药物治疗与预后相关有统计学意义(P0.05).多因素分析显示:无合并肝硬化(P=0.012)、Child-Pugh分级为A级(P=0.000)、有接受手术(P=0.020)及BCLC分期为0-B期(P=0.006)为影响三亚地区黎族原发性肝癌患者综合治疗后远期疗效的保护因素.结论:三亚地区黎族原发性肝癌患者经手术、TACE、分子靶向治疗、局部消融治疗等综合治疗获得了较长的生存时间,早期发现和早期接受手术治疗以及较好的肝功能状态等综合治疗仍然为三亚地区黎族原发性肝癌患者有效的治疗模式.     

肿瘤切除前TACE对巴塞罗那临床肝癌分期B期患者预后的影响

目的探讨肿瘤切除术前行经皮股动脉穿刺肝动脉化疗栓塞术（TACE）对巴塞罗那临床肝癌（BCLC）分期B期患者预后的影响。方法对309例首次行肝癌切除术的BCLC分期B期患者的临床资料进行回顾性分析,根据术前是否行TACE分为联合组和手术组,用两独立样本t检验和PearsonX2检验比较两组一般临床资料,用Log—rank检验和Cox比例风险回归模型比较两组生存率。结果两组一般临床资料无统计学差异（P〉0．05）;联合组和手术组中位生存期分别为36、26个月,组间比较P〈0．05（X2=9．226）;治疗方式、肿瘤直径、手术切缘和血清AFP水平是影响患者生存率的危险因素（P〈0．05）,且治疗方式是影响患者预后的独立危险因素（RR为1．576,95％CI为1．157—2．146,P=0．004）。结论对于BCLC分期B期患者,在切除术前给予辅助性TACE治疗有望延长术后生存时间。     

肝细胞癌四种临床分期系统预后判断和治疗指导价值的比较

Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.     

肝细胞癌四种临床分期系统预后判断和治疗指导价值的比较

Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.     

Evaluation of predictive value of CLIP, Okuda, TNM and JIS staging systems for hepatocellular carcinoma patients undergoing surgery

BACKGROUND: An accurate staging system is required to assess hepatocellular carcinoma (HCC) patients in order to benefit from hepatic resection before surgery. Cancer of the Liver Italian Program (CLIP) score was considered to be better than the Okuda staging system to predict survival. Japan Integrated Staging Score (JIS score) includes tumor, nodes, metastases (TNM) stage and Child-Pugh grade as a new staging system for HCC. The purpose of the present paper was to compare the CLIP, Okuda, TNM and JIS staging systems for HCC patients undergoing surgery. METHODS: From 1991 to 1995, 599 patients undergoing hepatic resection for HCC from four medical centers in Taiwan were evaluated. All patients were classified by Okuda, CLIP, TNM and JIS systems. Factors associated survivals were analyzed. RESULTS: There was no statistical difference in survival between CLIP 0 and 1 patients, or among CLIP 2-4 patients. The prognostic validation of the Okuda and CLIP scoring systems in discriminating survival in HCC patients undergoing surgery was not satisfied. The TNM system was successful in predicting survival for HCC patients undergoing surgery. The JIS score could also differentiate survivals for those patients except for JIS 3. By multivariate analysis, age > or =60 years old, serum albumin <3.5 g/dL, tumor size >5 cm and TNM stage were associated with survival. CONCLUSION: Both the Okuda and CLIP systems are not superior to TNM staging for HCC patients who undergo surgical resection. Whether JIS score is feasible for those patients with advanced HCC needs further evaluation.     

Comparison of seven prognostic staging systems in patients who undergo hepatectomy for hepatocellular carcinoma

BACKGROUND/AIMS: Various staging systems containing both the tumor and liver function factors for hepatocellular carcinoma (HCC) have been proposed. The aim of this study was to evaluate the appropriate staging system in patients received hepatic resection for HCC. METHODOLOGY: The prognosis of the 235 patients who had undergone hepatectomy in these 15 years were analyzed according to the 7 staging systems, the Cancer of the Liver Italian Program (CLIP) score, the Barcelona Clinic Liver Cancer (BCLC) staging, the Groupe d'Etude et de Traitment du Carcinome Hépatocellulaire (GETCH) classification, the Chinese University Prognostic Index (CUPI) grade, the Japan Integrated Staging (JIS) score, modified JIS (mJIS) score, and Tokyo score. The capabilities to differentiate the postoperative survival between the neighboring score in each staging system were examined. Statistical analyses of the log-rank test, linear trend test, likelihood ratio (LR) test, Akaike Information Criteria (AIC), and Harrels' c-index were used. RESULTS: The patients were widely distributed in the most of the staging system with the exceptions of GETCH classification and CUPI grade where almost all patients were classified to only the two groups. CLIP, JIS, mJIS, and Tokyo scores significantly differentiated the postoperative survival rate between 2 or 3 neighboring scores, whereas other staging systems only did between one. Statistical evaluations of prognostic stratification by the LR test, AIC, and Harrels' c-index showed that the JIS score system was the best among the 7 staging systems. CONCLUSIONS: JIS score is the best staging system for HCC in patients who undergo hepatectomy.     

Value of the model for end-stage liver disease for predicting survival in hepatocellular carcinoma patients treated with transarterial chemoembolization

Objective. The aim of this study was to evaluate the prognostic value of the model for end-stage liver disease (MELD) and its modified forms, and to compare these scoring systems with other staging systems for hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). Material and methods. A total of 325 patients who underwent TACE for the initial treatment of HCC between January 2000 and May 2007 were enrolled in the study. Before TACE was carried out, MELD, MELD-Na, Child-Pugh score, Okuda stage, CLIP score, JIS score, BCLC stage, and UICC stage were checked. After one month, ?MELD and ?MELD-Na were calculated. Results. Mean MELD/MELD-Na/?MELD/?MELD-Na scores were 7.5±3.7, 8.0±4.7, ?0.2±3.5 and 0.04±4.5, respectively. MELD (p=0.009) and MELD-Na (p=0.017) significantly correlated with survival, but ?MELD and ?MELD-Na did not (p >0.05). The Child-Pugh score and other staging systems correlated significantly with survival (p <0.05). The AUROC values for 3, 12, and 36 months’ survival were 0.633, 0.545, and 0.615 for MELD; 0.655, 0.555, and 0.612 for MELD-Na; 0.639, 0.616, and 0.691 for Child-Pugh score; 0.714, 0.662, and 0.717 for the Okuda score; 0.837, 0.86, and 0.792 for the CLIP score; 0.859, 0.814, and 0.808 for the JIS score; 0.846, 0.833, and 0.749 for BCLC stage; and 0.878, 0.812, and 0.735 for UICC stage, respectively. Conclusions. MELD and MELD-Na showed good correlations with survival, especially for patients with early-stage disease. However, these were not superior to those of other staging systems or Child-Pugh score. These parameters should only be used as supportive data.     

The model for end-stage liver disease based cancer staging systems are better prognostic models for hepatocellular carcinoma: a prospective sequential survey

OBJECTIVE: Liver cirrhosis is a major component in staging for hepatocellular carcinoma (HCC). The model for end-stage liver disease (MELD) is a better prognostic predictor for cirrhotic patients compared to the Child-Turcotte-Pugh (CTP) system, which is a parameter in Cancer of Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), and Japan Integrated Scoring (JIS) system. AIM: To investigate if the MELD-based models have a better prognostic ability. METHODS: In the MELD-based model, the CTP class was replaced with MELD score at cutoffs of <10, 10-14, and >14. The modified systems were prospectively compared with the original counterpart in 430 consecutive HCC patients. Using 6-month mortality as the end point, the area under receiver operating characteristic curve (AUC) between the original and modified system was compared sequentially on a 3-monthly basis. RESULTS: At the final inspection, the modified CLIP and JIS system had a significantly higher AUC compared to the original system (0.92 vs 0.893 for CLIP, P < 0.018; 0.88 vs 0.842 for JIS, P= 0.002), but there was no significant difference for the BCLC system (0.848 vs 0.841, P= 0.561). Survival analysis showed modified CLIP and JIS, and to a lesser extent, modified BCLC system, had a higher homogeneity likelihood ratio and discriminatory ability linear trend, and a lower Akaike information criterion in the Cox multivariate model, indicating a better discriminatory ability for different stage categories. CONCLUSIONS: The MELD-based CLIP and JIS staging systems have an improved predictive ability compared to the original system and are feasible models for HCC staging in the MELD era.     

Prognosis of hepatocellular carcinoma in anti-HCV positive cirrhotic patients: a single-centre comparison amongst four different staging systems

BACKGROUND: Epidemiological studies have foreseen an increase in the incidence of hepatocellular carcinoma (HCC) in the near future and it is estimated that this trend will mostly affect hepatitis C virus (HCV) positive cirrhotic patients. Therefore, accuracy of HCC staging is an important clinical issue. AIM: To investigate the prognostic usefulness of a series of newly proposed HCC prognostic systems such as the Cancer of the Liver Italian Program (CLIP) score, the Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire (GRETCH) model and the Barcelona Clinic Liver Cancer (BCLC) staging classification when compared with the usefulness of a known staging system such as the Okuda staging system in a group of anti-HCV positive cirrhotic patients with HCC seen at a single centre. METHODS: Okuda stage, CLIP score, GRETCH model and BCLC stages were retrospectively computed in 81 anti-HCV positive cirrhotic patients with HCC. We evaluated and compared the ability of these methods to assess survival prognosis. RESULTS: As of December 2001, 51 patients had died and overall median survival was 18 months. All the staging systems were able to identify various patient subgroups with different survival. The CLIP score, the GRETCH model and the BCLC staging classification were better at characterizing the 1-year prognosis of the patients when compared with the Okuda staging system, whilst the 3-year prognostic evaluation was improved only by using the CLIP score or the BCLC staging classification. CONCLUSIONS: The prognostic value and usefulness of the CLIP score, the GRETCH model and the BCLC staging classification was reproduced in a single-centre analysis of anti-HCV positive HCC cirrhotic patients. These scores provided a prognostic assessment of our patients which is superior to what was obtained by the Okuda staging system.     

Comparison of the usefulness of three staging systems for hepatocellular carcinoma (CLIP, BCLC, and JIS) in Japan

OBJECTIVES: We retrospectively compared the usefulness of three different staging systems for hepatocellular carcinoma (HCC), the Cancer of the Liver Italian Program (CLIP) scoring system, the Barcelona Clinic Liver Cancer (BCLC) classification system, and the Japan Integrated Staging (JIS) system, in terms of patient distribution and survival rates. METHODS: Subjects were 1,508 patients diagnosed as having initial HCC during the period of 1976-2003. The disease was staged in all patients by means of the three staging systems, and the distribution of patients across stages and associated survival rates were compared between systems. In addition, comparisons were made on the basis of the time of diagnosis: 1976-1990 (n = 497) and 1991-2003 (n = 1,011). RESULTS: Patients were evenly distributed across stages within each staging system, and survival rates differed between stages except for BCLC C and D. During the period 1991-2003, when HCCs were smaller at diagnosis, JIS system is in particular yielded even distribution of patient across stages and marked differences in survival rates. CONCLUSIONS: Overall, the CLIP and the JIS scoring systems proved to be suitable for patients in Japan with HCC. The CLIP staging systems proved to be more suitable before 1991. In contrast, the JIS system was the most suitable after 1990, when early detection and early treatment of HCC became common. The JIS system is, therefore, the appropriate system in this era of early detection and treatment of HCC.     

Prognostic factors for survival in patients with hepatocellular carcinoma after radiofrequency ablation]

BACKGROUND/AIMS: Currently there is no consensus on which staging system is the best in predicting the survival of patients with hepatocellular carcinoma (HCC). The aim of this study was to identify independent factors to predict survival and to compare 4 available prognostic staging systems in patients with early HCC after radiofrequency ablation. METHODS: We retrospectively studied 100 Korean patients with early HCC. Prognostic factors for survival were analysed by univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional hazard regression models. Okuda, Cancer of the Liver Italian Program (CLIP), TNM and Japanese integrated staging score (JIS score) were evaluated before the treatments. RESULTS: Overall survival rates of 12, 24 and 36 months were 89%, 76%, and 64% respectively and the mean survival duration was 45 months. Multivariable analysis showed that albumin, total bilirubin and size of tumor were independent prognostic factors. Multivariate analysis showed that TNM and JIS score staging systems were significant staging systems for the prediction of prognosis. CONCLUSIONS: Both TNM and JIS score are more effective than the Okuda and CLIP staging systems in stratifying patients into different risk groups with early HCC. However, JIS score gives better prediction of prognosis in patients with HCC after radiofrequency ablation.     

Validation of a new prognostic staging system for hepatocellular carcinoma: the JIS score compared with the CLIP score

The Japan Integrated Staging score (JIS score), which combines the Child-Turcotte-Pugh classification and tumor-node-metastasis staging, has been proposed as a better prognostic staging system for hepatocellular carcinoma (HCC) than the Cancer of the Liver Italian Program (CLIP) scoring system. In this study, validation was performed among a larger patient population. A total of 4,525 consecutive patients with HCC who had been diagnosed at five institutions were included. Stratification ability, prognostic predictive power, and reproducibility were analyzed and compared with results from the CLIP scoring system. Only 45% (1,951 of 4,525) of all patients were categorized as early stage HCC according to JIS score (0 or 1), whereas 63% (2,878 of 4,525) of the patients were categorized as having a CLIP score of 0 or 1. Significant differences in survival curves were not observed among CLIP scores 3 to 6. In contrast, survival curves showed significant differences among all the JIS scores. The same JIS scoring subgroups showed a similar prognosis, and good internal reproducibility was observed in each of the institutions. Multivariate analysis of the prognosis in all 4,525 patients proved the JIS score to be the best prognostic factor. Furthermore, the Akaike information criteria proved that the JIS scoring system was statistically a better model for predicting outcome than the CLIP scoring system. In conclusion, the stratification ability and prognostic predictive power of the JIS score were much better than that of the CLIP score and were simple to obtain and remember.     

Modified Japan Integrated Staging is currently the best available staging system for hepatocellular carcinoma patients who have undergone hepatectomy

Background We previously reported the effectiveness of the modified Cancer of the Liver Italian Program (CLIP) score in hepatocellular carcinoma (HCC) staging. To determine the best predictive staging system for HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 230 Japanese HCC patients following hepatic resection. Methods We compared overall survival as predicted by different staging systems: the tumor node metastasis (TNM) system by the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), the modified JIS score using liver damage grade, the CLIP score, and our modified CLIP score using protein induced by vitamin K absence or the antagonist II (PIVKA-II). Results By a univariate analysis the PIVKA-II level (cut-off level, 400 mAU/ml) was significantly associated with patient survival (P = 0.031); however, alpha-fetoprotein level was not related to survival. Liver damage grade was significantly associated with patient survival (P = 0.039), although Child-Pugh classification was not related to survival. Univariate analysis showed that prediction of survival, according to disease stage, was better with the modified JIS score than with the TNM system, CLIP, modified CLIP, or JIS score. Multivariate analysis showed the modified JIS score showed the best ability to predict overall survival according to disease stage (Hazard ratio, 1.77; P = 0.002), and its Akaike information criteria statistic was the lowest (634.3). Conclusions The modified JIS score, a staging system that combines tumor factors and hepatic function, is a better predictor of prognosis than other systems in HCC patients who have undergone hepatic resection.     

Prospective validation of the Chinese University Prognostic Index and comparison with other staging systems for hepatocellular carcinoma in an Asian population

Background and Aim: Hepatitis B viral (HBV) infection is the predominant etiology of hepatocellular carcinoma (HCC) in Asia. Our group previously reported a staging system known as the Chinese University Prognostic Index (CUPI) for HCC populations of which HBV infection is the predominant etiology. This study aims to validate CUPI and compare with other published staging systems. Methods: We analyzed a prospective cohort of patients with newly diagnosed HCC from 2003 to 2005. All patients were staged with CUPI, Barcelona Clinic Liver Cancer Classification (BCLC), Cancer of the Liver Italian Program score (CLIP), tumor‐node‐metastasis (TNM) and Okuda systems at diagnosis. They were followed with survival data and the performance of each staging system (in terms of homogeneity, discriminatory ability and monotonicity of gradient) were analyzed and compared. Results: A total of 595 patients (80.2% with chronic HBV infection) were analyzed. The median follow‐up was 41.4 months and the median survival was 6.6 months. Multivariate analyses identified symptomatic disease, ascites, vascular involvement, Child‐Pugh‐stage, alpha‐fetoprotein and treatment to be the independent prognostic factors. CUPI could identify three groups with statistically significant survival difference (P < 0.0001). Both CUPI and CLIP had the most favorable performance in terms of discriminatory ability, homogeneity and monotonicity. CUPI performed the best in predicting 3‐month survival while CLIP performed better in predicting the outcome of 6‐ and 12‐month survival rate. BCLC was inferior to CLIP and CUPI in the overall performance. Conclusion: We have validated CUPI in a population composed of predominant HBV‐related HCC. CUPI is an appropriate staging system for HBV‐related HCC. In patients with advanced HCC, both CUPI and CLIP offer good risk stratification.