Validation of Three Staging Systems for Hepatocellular Carcinoma (JIS Score, Biomarker-Combined JIS Score and BCLC System) in 4,649 Cases from a Japanese Nationwide Survey

Abstract Background A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Here, we evaluated the effects of SMI and IMF on the survival of Indonesian HCC patients, whose characteristics differ from those of Japanese patients.Methods SMI and mean muscle attenuation (MA) were evaluated using computed tomography images of the third lumbar vertebra (L3) in a prospective cohort of 100 Indonesian HCC patients. Clinical, laboratory and body composition data were analysed using the Kaplan–Meier method and Cox regression model to investigate which factors are associated with prognosis.Results Of 100 patients, 31 were diagnosed with sarcopenia (L3 SMI value ≤36.2 cm 2 /m 2 for men and ≤29.6 cm 2 /m 2 for women), and 65 had IMF deposition (MA value ≤44.4 HU for men and ≤39.3 HU for women). These groups had shorter median survival than the reference groups (both P <0.0001). In multivariable analysis, sarcopenia (hazard ratio [HR], 1.921; P = 0.016), IMF deposition (HR, 3.580; P <0.001), Barcelona Clinic Liver Cancer (BCLC) stages C and D (HR: 2.396, P <0.01 and HR: 6.131, P <0.01, respectively), Japan Integrated Staging (JIS) score 4 (HR: 2.067, P = 0.020), and male gender (HR: 3.211, P <0.001) were independently associated with mortality.Conclusion Sarcopenia and IMF deposition showed superior value in combination with BCLC stage and JIS score for predicting the survival of Indonesian HCC patients. Increased awareness and strategies to prevent or reverse these factors might improve patient outcomes. (Electric word counts: 249)

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Talin-1 Gene Expression as a Tumor Marker in Hepatocellular Carcinoma Patients: A Pilot Study

The Open Biomarkers Journal ◽

10.2174/1875318302010010015 ◽

2020 ◽

Vol 10 (1) ◽

pp. 15-22 ◽

Cited By ~ 2

Author(s):

Amal A. Mohamed ◽

Naglaa El-Toukhy ◽

Doaa M. Ghaith ◽

Ingy Badawy ◽

Sara M. Abdo ◽

...

Keyword(s):

Gene Expression ◽

Hepatocellular Carcinoma ◽

Mononuclear Cells ◽

Tumor Staging ◽

Serum Levels ◽

Peripheral Blood Mononuclear ◽

Primary Liver Tumor ◽

Staging Systems ◽

Diagnostic Role ◽

Serum Alpha Fetoprotein

Background & Aims: Hepatocellular Carcinoma (HCC) is the most common primary liver tumor. It is the second most common cancer in men and the sixth in women in Egypt. One of the proteins participating in the trans-endothelial migration is Talin-1. It also has a role in the formation and metastasis of different types of cancer. This study aimed to evaluate the diagnostic impact of Talin-1 gene expression in HCC Egyptian patients. Methods: Our study included forty HCC patients, thirty liver cirrhosis patients without HCC and thirty healthy subjects. For all groups, clinical and biochemical parameters were investigated. Tumor characteristics were assessed and tumor staging was done using Okuda, CLIP, VISUM and Tokyo staging systems. In addition, Serum Alpha-Fetoprotein (AFP) levels were assayed using Enzyme Immunoassay (EIA) and Talin-1 gene expression was assessed in the Peripheral Blood Mononuclear Cells (PBMCs) via quantitative real-time Polymerase Chain Reaction (PCR). Results: Talin-1 gene expression was significantly upregulated in HCC patients in comparison to cirrhotic and control subjects. The Receiver Operating Characteristic (ROC) analysis indicated that Talin-1 gene expression surpasses serum levels of AFP in the diagnosis of HCC. In particular, the cut off value of 9.5 (2-∆∆Ct) recorded an AUC of 85.7% with a sensitivity of 93.3% and specificity of 80%. Conclusion: Our data confirmed an évident diagnostic role of Talin-1 gene expression for HCC detection.

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IDDF2021-ABS-0015 Comparison of Hong Kong liver cancer with barcelona clinic liver cancer staging systems in a cohort of Egyptian patients with hepatocellular carcinoma

10.1136/gutjnl-2021-iddf.63 ◽

2021 ◽

Author(s):

Reham Ashour ◽

Mai Abozeid ◽

Hossam Taha ◽

Sally ELKhadry ◽

Osama El-Abd ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hong Kong ◽

Liver Cancer ◽

Cancer Staging ◽

Barcelona Clinic Liver Cancer ◽

Staging Systems ◽

Egyptian Patients

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ASO Author Reflections: Impact of Bile Duct Tumor Thrombus in Hepatocellular Carcinoma—Does it Influence Staging Systems?

Annals of Surgical Oncology ◽

10.1245/s10434-021-10823-3 ◽

2021 ◽

Author(s):

Jun-Yi Wu ◽

Ju-Xian Sun ◽

Shu-Qun Cheng ◽

Mao-Lin Yan

Keyword(s):

Hepatocellular Carcinoma ◽

Bile Duct ◽

Tumor Thrombus ◽

Bile Duct Tumor ◽

Staging Systems

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Evaluation of seven different staging systems for alpha-fetoprotein expression in hepatocellular carcinoma after hepatectomy

Tumor Biology ◽

10.1007/s13277-013-0646-x ◽

2013 ◽

Vol 34 (2) ◽

pp. 1061-1070 ◽

Cited By ~ 7

Author(s):

Jianguo Zhou ◽

Tao Yan ◽

Xinyu Bi ◽

Hong Zhao ◽

Zhen Huang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Alpha Fetoprotein ◽

Staging Systems

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A new staging system for radiotherapy-based treatment of hepatocellular carcinoma: A multicenter cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16155 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16155-e16155

Author(s):

Ting-Shi Su ◽

Shi-Xiong Liang ◽

Li-Qing Li ◽

Qiu-Hua Liu ◽

Xiao-Fei Zhu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

External Validation ◽

Staging System ◽

Time Dependent ◽

Multicenter Cohort Study ◽

Discriminatory Ability ◽

Training Cohort ◽

Multicenter Cohort ◽

Staging Systems

e16155 Background: External beam radiation therapy has been used as a palliative to radical treatment of hepatocellular carcinoma (HCC) depending on different tumor status, liver function and patient's general state of health. The existing models of HCC staging cannot perfectly predict the prognosis of radiotherapy. In this study, we aimed to set up a new staging system for radiotherapy-based treatment by incorporating bilirubin-albumin (ALBI) grade and tumor status for the prognostic classifications of HCC. Methods: This multicenter cohort study included 878 HCC patients who received radiotherapy-based treatment. A new staging system was established: stage I, solitary nodule without macrovascular invasion or 2-3 nodules with no more than 3.0 cm each other and PS 0-2 (Ia: ALBI-1 grade; Ib: ALBI-2 or 3 grade); stage II: 2-3 nodules with anyone more than 3.0 cm or ≥4 nodules and PS 0-2 (IIa: ALBI-1 grade; IIb: ALBI-2 grade); stage III: macrovascular invasion or regional lymph node metastasis or distant metastasis and PS 0-2 (IIIa: ALBI-1 grade; IIIb:ALBI-2 grade); stage IV: ALBI-3 grade without stage I patient or/and PS score 3-4. The new modified staging system and the existing staging systems, such as the BCLC, TNM, CNLC staging systems were used for prognostic analysis. All patients were separated into different stages and substages. The long-term overall survival outcomes and time-dependent receiver operating characteristic (ROC) were analyzed. Results: A training cohort of 595 patients underwent stereotactic body radiotherapy (SBRT) from 2011 to 2017 and an external validation cohort of 283 patients underwent intensity-modulated radiotherapy (IMRT) from 2000 to 2013 were included into establishing and validating the new staging system. In the training cohort, the median follow-up time was 55 months (range, 6–100 months), and the new staging system had a good discriminatory ability to separate patients into different stages with 4 notably different curves and substages with 7 notably different curves. BCLC staging could not differentiate stage 0 to A, and stage C to D in these selected patients. TNM staging could not completely distinguish stage IIIb to IV, but also stage Ia to Ib. CNLC staging could not differentiate among stage IIIa, IIIb, and IV. In the external validation, the median follow-up time was 95 months (range, 9–120 months), and the new staging system also had a good discriminatory ability to separate patients into different stages with 4 notably different curves and substages with 7 notably different curves. The new staging system had a better area under curve of time-dependent ROC than BCLC, TNM and CNLC staging in both SBRT and IMRT cohorts. Conclusions: The new modified (Su’s) staging system could provide a good discriminatory ability to separate patients into different stages and substages after radiotherapy treatment. It may be used to supplement the other HCC staging systems.

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Tumors of the Liver and Biliary Tract

DeckerMed Surgery ◽

10.2310/surg.2250 ◽

2014 ◽

Author(s):

Gabriela M. Vargas ◽

Purvi Parikh ◽

Kimberly M Brown

Keyword(s):

Hepatocellular Carcinoma ◽

Gallbladder Cancer ◽

Biliary Tract ◽

Clinical Evaluation ◽

Tumor Staging ◽

Colorectal Metastases ◽

Distal Cholangiocarcinoma ◽

Cystic Tumors ◽

Liver Cancers ◽

Staging Systems

This review discusses several different types of tumors that affect the liver, biliary tree, and gallbladder. Primary and secondary liver cancers are discussed, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, colorectal metastases, neuroendocrine metastases, and noncolorectal, nonneuroendocrine metastases. Clinical evaluation, investigative studies, tumor staging, and treatment options are presented for each. Benign or premalignant hepatic lesions are also discussed, including the appropriate workup and surgical options for hemangioma, hepatic adenoma, focal nodular hyperplasia, and nonparasitic cystic tumors. Cancers of the biliary tract (cholangiocarcinomas) are subdivided into intrahepatic and extrahepatic cholangiocarcinomas. The latter are subdivided into hilar and distal cholangiocarcinoma; their clinical evaluation, investigative studies, staging, and management are discussed. The clinical evaluation, investigative studies, testing, imaging, staging, and management are presented for gallbladder cancer, including incidentally discovered gallbladder cancer and gallbladder polyps. Figures include the anatomic divisions of the liver and Brisbane terminology for resections, CT and MR images showing characteristic features of the liver and biliary tract tumors, Bismuth-Corlette classification of hilar cholangiocarcinoma, and algorithms for the management of hepatocellular carcinoma and neuroendocrine metastases. Tables include the American Joint Committee on Cancer’s classification and staging systems for hepatocellular carcinoma, cholangiocarcinoma, and gallbladder cancer; Brisbane terminology for liver resections; and neuroendocrine tumors with their corresponding biochemical markers. This review contains 14 figures, 7 tables, and 83 references.

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