Comparison of a new prognostic system and five current staging systems in predicting the survival rate of patients with advanced hepatocellular carcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 193-193
Author(s):  
Zhan-Hong Chen ◽  
Xing Li ◽  
Min Dong ◽  
Xiao-Kun Ma ◽  
Xiang-Yuan Wu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Survival Rate ◽  
Liver Cancer ◽  
Staging System ◽  
Locoregional Therapy ◽  
Score System ◽  
Advanced Hcc ◽  
Prognostic System ◽  
Staging Systems

193 Background: Prognosis of patients with advanced HCC is very poor, median overall survival varies from 3 to 6 months. Life expectancy more than 3 months is one inclusion criteria for molecular targeted drugs in clinical tirals. We have established a new prognostic system called SYSU system (variables and risk classification criteria are listed below, reported in MASCC 2013) and now we want to compare this new prognostic system and 5 current staging systems in predicting the survival rate of patients with advanced HCC. Methods: From September 2008 to June 2010, a total of 253 patients with advanced HCC who were not amendable to locoregional therapy were analyzed. The median follow-up is 38.5 months and the median survival is 7 months. Data were collected to classify patients according to our new system(SYSU system), Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma (BCLC), Advanced Liver Cancer Prognostic System (ALCPS), Chinese University Prognostic Index staging system for HCC (CUPI), OKUDA score system and French scoring system(GETCH) at diagnosis. OS and 3-month OS were the end points used in the analysis. Results: When predicting 3-month survival, ROC analysis show AUC of SYSU system, ALCPS, CUPI,OKUDA, GETCH and BCLC is 0.822,0.821,0.777,0.756,0.688 and 0.621. AUC of SYSU system and ALCPS is similar and they are significantly better than the other four staging system (p<0.05). When predicting overall survival, likelihood ratio test show χ2 of SYSU system, ALCPS, CUPI,OKUDA, GETCH and BCLC is 97.7,85, 50.5, 46.4,22.6 and 8.4 and AIC of SYSU system, ALCPS, CUPI,OKUDA, GETCH and BCLC is 1939,1952,1986,1990,2014 and 2028. Our SYSU system has best performance in terms of discriminatory ability, homogeneity and monotonicity. Conclusions: Our SYSU system is the best score system in prediction of OS and 3-month OS among the 6 systems analyzed for Chinese advanced HCC patients. [Table: see text]

Comparison of a new prognostic system and other three current staging systems in predicting the survival rate of patients with HBV-associated advanced hepatocellular carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 347-347
Author(s):  
Ying-Fen Hong ◽  
Zhan-Hong Chen ◽  
Qu Lin ◽  
Min Dong ◽  
Xing Li ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Rate ◽  
Performance Status ◽  
Staging System ◽  
Ratio Test ◽  
Advanced Hepatocellular Carcinoma ◽  
Carcinome Hépatocellulaire ◽  
Advanced Hcc ◽  
Prognostic System ◽  
Staging Systems

347 Background: HBV infection is one of the main reasons for hepatocellular carcinoma(HCC). Patients with advanced HBV-associated HCC have poor prognosis. Life expectancy more than 3 months is one inclusion criteria for molecular targeted drugs in clinical trials. Prediction of 3-month OS and OS survival rate of advanced HCC patients is very important. A new prognostic system called PS-JIS system (proposed Performance Status combined Japan Integrated Staging system, variables and risk classification criteria are listed below) was established in 2015 and now we want to compare this new prognostic system and other three current staging systems in predicting the survival rate of patients with advanced HBV-associated HCC. Methods: From September 2008 to June 2010, 220 patients with advanced HCC who didn’t receive anti-cancer therapy recommended by NCCN guidelines were analyzed. Data were collected to classify patients according to CLIP (Cancer of the Liver Italian Program), PS-JIS, GETCH(Groupe d’étude et de Traitement du Carcinome Hepatocellulaire) and TNM staging system at diagnosis. OS and 3-month OS were the end points used in the analysis. Results: When predicting 3-month survival, ROC analysis show AUC of CLIP, PS-JIS, GETCH and TNM is 0.806, 0.761, 0.654 and 0.643. AUC of CLIP and PS-JIS is similar (P=0.1174), both significantly higher than the other two staging system (P<0.01). When predicting overall survival, likelihood ratio test show χ2 of CLIP, PS-JIS, GETCH and TNM is 74.00, 39.71, 23.09, 21.40. AIC of CLIP, PS-JIS, GETCH and TNM is 1601.46, 1635.80, 1655.06, 1654.77. The CLIP system has best performance in terms of discriminatory ability, homogeneity and monotonicity. Conclusions: The PS-JIS and CLIP systems were both the best score system in prediction of 3-month OS among the 4 systems and CLIP was still the best to predict OS analyzed for Chinese advanced HBV-associated HCC patients. [Table: see text]

A population-based analysis of prognostic factors in patients with advanced hepatocellular carcinoma treated with sorafenib.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 163-163
Author(s):  
Alan D. Smith ◽  
Winson Y. Cheung
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Elevated Serum ◽  
Advanced Hepatocellular Carcinoma ◽  
Clinical Factors ◽  
Conventional Chemotherapy ◽  
Sorafenib Treatment ◽  
Advanced Hcc ◽  
Staging Systems

163 Background: Available clinical prognostic scoring systems for advanced hepatocellular carcinoma (HCC) were developed in the era of conventional chemotherapy. In 2008, the molecularly targeted agent sorafenib became the new standard of care for advanced HCC due to its survival benefit. The utility of these prognostic models in the setting of sorafenib is unclear. Our aims were to assess for new prognostic factors in patients treated with sorafenib and compare these with known prognostic systems. Methods: All patients diagnosed with advanced HCC from 2008 to 2010 in British Columbia, Canada and treated with sorafenib at any 1 of 5 regional cancer centers were eligible. Based on the established Okuda, CLIP, Barcelona, and French staging systems, we collected baseline demographic and disease characteristics of patients prior to receipt of sorafenib. Multivariate logistic regression models were constructed to examine for associations between these clinical factors and overall survival. Results: Of 183 patients identified, 152 were evaluable: median age was 63 years, 78% were men, average number of sorafenib treatment was 5.3 cycles, and median overall survival was 9.6 months. The prevalence of hepatitis B, hepatitis C, and alcohol-related liver disease were 32%, 15%, and 11%, respectively. Univariate analyses showed that poor performance status, presence of clinical ascites, as well as elevated serum AST, GGT, ALP, bilirubin and platelet levels were each associated with worse overall survival (all p<0.05). In multivariate analyses, however, none of these clinical factors continued to be independently predictive of outcome (all p>0.05). Conclusions: Traditional clinical prognostic factors developed in the era of conventional chemotherapy do not appear to have the same prognostic utility in this contemporary Western cohort of advanced HCC patients treated with sorafenib. This observation underscores the need to identify molecular biomarkers that provide better prognostic information.

scholarly journals Comparison of four staging systems to predict overall survival rate in Indonesian hepatocellular carcinoma patients

2017 ◽  
Vol 28 ◽  
pp. x75
Author(s):  
K. Waren ◽  
A.D. Vatvani ◽  
D. Widjaja ◽  
M. Leonardo ◽  
I D G K Thobias Adiya ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Survival Rate ◽  
Overall Survival Rate ◽  
Staging Systems

Prognostic factors of survival in 236 advanced hepatocellular carcinoma patients enrolled in prospective clinical trials of systemic therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15632-e15632 ◽  
Author(s):  
Z. Lin ◽  
D. Chang ◽  
Y. Shao ◽  
C. Hsu ◽  
C. Hsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Clinical Trials ◽  
Prognostic Factors ◽  
Systemic Therapy ◽  
Objective Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Phase Ii Trials ◽  
Advanced Hcc ◽  
Staging Systems

e15632 Background: Hepatocellular carcinoma (HCC) is a common malignant disease. Promising results of prospective clinical trials using systemic therapy for patients with advanced HCC are emerging. The aim of this study was to explore prognostic factors of survival in advanced HCC patients eligible for clinical trials of systemic therapy. Methods: From December 1990 to July 2005, 236 patients with unresectable HCC were enrolled into 6 phase II trials of systemic therapy using the following regimens: (1) oral etoposide + tamoxifen, (2)doxorubicin + tamoxifen, (3)IFN-α2b + doxorubicin + tamoxifen, (4)pegylated liposomal doxorubicin, (5)thalidomide, and (6)arsenic trioxide. Univariate and multivariate analyses of 23 relevant clinical characteristics/staging systems were used to identify prognostic factors of survival. Results: Baseline characteristics: median age 55; male/female: 192/44; HBsAg(+) 71%; anti-HCV(+) 30%; Okuda stage I/II/III: 42%/55%/3%; AJCC stage III/IV: 30%/61%; BCLC stage B/C/D: 1%/94%/5%; CLIP score 0–3/4–6: 70%/30%; portal vein thrombosis 53%; extrahepatic metastasis 59%; prior chemoembolization 46%. The objective response rate according to WHO criteria was 11.4%. The median overall survival was 118 days (95% CI, 103–133). In the multivariate analysis, significant predictors of a shorter overall survival were: HBsAg(+) with a hazard ratio (HR) = 1.808 (95% CI, 1.121–2.916; P= 0.015), symptomatic with HR = 1.745 (95% CI, 1.072–2.840; P= 0.025), ECOG≥2 with HR = 1.763 (95% CI, 1.040–2.988; P= 0.035), and high BCLC stage with HR = 3.282 (95% CI, 1.129–9.541; P= 0.029). Conclusions: Patients with advanced HCC who are eligible for systemic therapeutic trials have patient- and disease-related prognostic factors. Positive HBsAg, symptomatic, ECOG performance≥2, and high BCLC stage predict a shorter overall survival. No significant financial relationships to disclose.

Staging of advanced hepatocellular carcinoma patients in the targeted therapy era.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 209-209
Author(s):  
Neeraj Nailesh Shah ◽  
Manal Hassan ◽  
Lianchun Xiao ◽  
James L. Abbruzzese ◽  
Jeffrey Morris ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Targeted Therapy ◽  
Prognostic Index ◽  
Predictive Ability ◽  
Staging System ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc ◽  
Sorafenib Group ◽  
Staging Systems

209 Background: Several hepatocellular carcinoma (HCC) staging systems are currently available. However, they were all developed before the targeted therapy era prevailed in the last decade which has changed the natural history of the disease. Our study goal was to test the performance of different HCC staging systems in patients with HCC who were treated at our institution during the last decade. Methods: We prospectively enrolled 438 patients from early 2000 to late 2009. Baseline clinicopathologic parameters and staging were available, including the TNM, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), Okuda, and Chinese University Prognostic Index (CUPI). We performed survival and cox-regression analyses, and compared the staging systems’ predictive ability using Harrell's C-index. Finally, we performed a subgroup analysis of 3 independent cohorts based on whether or not they received sorafenib, whether or not they had hepatitis, and whether or not they had cirrhosis. Results: The overall survival was 13.9 months. Overall, CLIP score was the most predictive staging system with a C-index of 0.71. 187 patients were treated with targeted therapies and 138 were treated with sorafenib after it was approved in 2007. CLIP score was the most predictive staging system with a C-index of 0.71 in the no sorafenib group, and 0.74 in the sorafenib group. In hepatitis patients, CLIP topped amongst all staging systems with a C-index of 0.75, and in patients without hepatitis, despite all staging systems having a poor predictive ability, CLIP score still had the highest C-index of 0.67. Similarly, CLIP score had the best predictive ability in patients with and without pre-existing liver cirrhosis, with C-indices of 0.73 and 0.68 respectively. There was no statistically significant interaction between CLIP score and hepatitis status, and CLIP score and liver cirrhosis. Thus, overall the CLIP score was the best predictive system in all cohorts. Conclusions: Our results suggest that the CLIP score has the highest stratification ability in our advanced HCC patient population, including several subgroups. Our study confirms the utility of the CLIP score to stratify advanced HCC patients in clinical trials.

Nano-Sized Drug Delivery Systems: Development and Implication in Treatment of Hepatocellular Carcinoma

2015 ◽  
Vol 33 (5) ◽  
pp. 675-682 ◽  
Author(s):  
Khan Farheen Badrealam ◽  
Mohammad Owais
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Cancer ◽  
Material Science ◽  
Drug Delivery Systems ◽  
Systems Development ◽  
Clinical Development ◽  
Nanoscale Systems ◽  
Advanced Hcc ◽  
The Status

Liver cancer results in enormous human toll worldwide. Over the years, various chemotherapeutic entities have been employed for treatment of advanced HCC; however, as of yet none embody attributes to improve overall survival. Following rapid advancement in nanotechnology, it is envisage that nanoscale systems may emerge as intriguing platforms to improve chemotherapeutic strategies against various cancers including liver cancer; with better insight in the understanding of pathophysiology of liver cancer and material science, the field of nanotechnology may bring newer hope to liver cancer treatment. Reckoning with these, we detailed the arsenal of nanoformulations that are in various stages of clinical development/ preclinical settings for the treatment of liver cancer together with providing a glimpse of the attributes of nanotechnology in revolutionizing the status of chemotherapeutic modalities.

Research on predictive value of five current staging systems in advanced hepatocellular carcinoma patients who received loco-regional therapies.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 237-237
Author(s):  
Zhan-Hong Chen ◽  
Li Wei ◽  
Ying-Fen Hong ◽  
Jin-Xiang Lin ◽  
Xing Li ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Predictive Value ◽  
Target Therapy ◽  
Statistical Significance ◽  
Staging System ◽  
Ratio Test ◽  
Advanced Hepatocellular Carcinoma ◽  
Ethanol Injection ◽  
Advanced Hcc ◽  
Staging Systems

237 Background: Many HCC patients are diagnosed at advanced stage and loco-regional therapies improve their prognosis. Transarterial chemotherapy with or without concomitant embolization(TACE) and percutaneous ethanol injection(PEJ) are two common loco-regional therapies.Overall survival(OS) of these patients varies differently. It is very important to identify who benefits most from loco-regional therapies. We research on five current staging systems’ predictive value. Methods: Our research analyzed 220 advanced HCC patients. They received TACE or PEJ and did not receive radical surgery, chemotherapy or target therapy. At first diagnosis all patients were classified according to CLIP (Cancer of the Liver Italian Program), Advanced Liver Cancer Prognostic System (ALCPS), Japan Integrated Scoring (JIS) system, Barcelona Clinic Liver Cancer Classification (BCLC) and model for end-stage liver diseases (MELD) score. 6 month OS, 1-year OS, 2-year OS and OS were the end points. Results: The median survival is 23.8 months. When predicting 6 month OS, AUC of CLIP, ALCPS, JIS, BCLC and MELD is 0.847, 0.724, 0.710, 0.521 and 0.509,respectively;When predicting 1-year OS, AUC of CLIP, ALCPS, JIS, BCLC and MELD is 0.872, 0.689, 0.693, 0.503 and 0.552,respectively; When predicting 2-year OS, AUC of CLIP, ALCPS, JIS, BCLC and MELD is 0.855, 0.683, 0.669, 0.503 and 0.553,respectively;AUC of CLIP is significantly higher than other four staging systems in predicting 6 month OS, 1-year OS, 2-year OS(P < 0.05), while AUC difference between ALCPS and JIS does not have statistical significance in predicting 6 month OS, 1-year OS, 2-year OS(P > 0.05). When predicting OS, likelihood ratio test shows χ2 of CLIP, ALCPS, and JIS is 90.2,13.1 and 16.5 respectively. AIC of CLIP, ALCPS and JIS is 1338, 1415 and 1411 respectively. CLIP has the highest χ2 value and the lowest AIC value. As for discriminatory ability, homogeneity and monotonicity, CLIP performs best. Conclusions: The best staging system in predicting 6 month OS, 1-year OS, 2-year OS and OS for advanced HCC patients who received loco-reginal therapies is CLIP.

scholarly journals Prognostic Value of Microvascular Invasion in Eight Existing Staging Systems for Hepatocellular Carcinoma: A Bi-Centeric Retrospective Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yan-Jun Xiang ◽  
Kang Wang ◽  
Yi-Tao Zheng ◽  
Hong-Ming Yu ◽  
Yu-Qiang Cheng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Prognostic Value ◽  
Staging System ◽  
Microvascular Invasion ◽  
Survival Outcomes ◽  
Entire Cohort ◽  
Significant Survival ◽  
Staging Systems ◽  
Survival Differences

BackgroundMicrovascular invasion (MVI) is a significant risk factor affecting survival outcomes of patients after R0 liver resection (LR) for hepatocellular carcinoma (HCC). However, whether the existing staging systems of hepatocellular carcinoma can distinguish the prognosis of patients with MVI and the prognostic value of MVI in different subtypes of hepatocellular carcinoma remains to be clarified.MethodsA dual-center retrospective data set of 1,198 HCC patients who underwent R0 LR was included in the study between 2014 and 2016. Baseline characteristics and staging information were collected. Homogeneity and modified Akaike information criterion (AICc) were compared between each system. And the prognostic significance of MVI for overall survival (OS) was studied in each subgroup.ResultsIn the entire cohort, there were no significant survival differences between Cancer of the Liver Italian Program (CLIP) score 2 and 3 (p = 0.441), and between Taipei Integrated Scoring System (TIS) score 3 and 4 (p = 0.135). In the MVI cohort, there were no significant survival differences between Barcelona Clinic Liver Cancer stages B and C (p=0.161), CLIP scores 2 and 3 (p = 0.083), TIS scores 0 and 1 (p = 0.227), TIS scores 2 and 3 (p =0.794), Tokyo scores 3 and 4 (p=0.353), and American Joint Committee on Cancer Tumor-Node-Metastasis 7th stage I and II (p=0.151). Among the eight commonly used HCC staging systems, the Hong Kong Liver Cancer (HKLC) staging system showed the highest homogeneity and the lowest AICc value in both the entire cohort and MVI cohort. In each subgroup of the staging systems, MVI generally exhibited poor survival outcomes.ConclusionsThe HKLC staging system was the most accurate model for discriminating the prognosis of MVI patients, among the eight staging systems. Meanwhile, our findings suggest that MVI may be needed to be incorporated into the current HCC staging systems as one of the grading criteria.

scholarly journals Treatment of Advanced Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Mahmoud Aryan ◽  
Ellery Altshuler ◽  
Xia Qian ◽  
Wei Zhang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Performance Status ◽  
Staging System ◽  
Tumor Burden ◽  
Systemic Review ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
Advanced Hcc ◽  
The Past

Hepatocellular Carcinoma (HCC) is the fifth most common cancer and represents the fourth most common cause of cancer related death worldwide. Treatment of HCC is dictated based upon cancer stage, with the most universally accepted staging system being the Barcelona Clinic Liver Cancer (BCLC) staging system. This system takes into account tumor burden, active liver function, and patient performance status. BCLC stage C HCC is deemed advanced disease, which is often characterized by preserved liver function (Child-Pugh A or B) with potential portal invasion, extrahepatic spread, cancer related symptoms, or decreased performance status. Sorafenib has been the standard treatment for advanced HCC over the past decade; however, its use is limited by low response rates, decreased tolerance, and limited survival benefit. Researchers and clinicians have been investigating effective treatment modalities for HCC over the past several years with a focus on systemic regimens, locoregional therapy, and invasive approaches. In this systemic review, we discuss the management of advanced HCC as well as the ongoing research on various treatment opportunities for these patients.

Surgical Treatment for Hepatocellular Carcinoma in the Era of Multiple Staging and Algorithm

2018 ◽  
Author(s):  
Suguru Yamashita ◽  
Katharina Joechle ◽  
Jean-Nicolas Vauthey
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Treatment Algorithm ◽  
Staging System ◽  
Cancer Staging ◽  
Barcelona Clinic Liver Cancer ◽  
Term Survival ◽  
American Joint Committee ◽  
Staging Systems ◽  
Surgical Treatments

A plethora of staging systems for hepatocellular carcinoma (HCC) has existed, as the management for HCC is made complex by the interplay of tumor characteristics and the health and underlying functions of both the patient and the liver. The majority of patients with HCC have nonsurgical HCC. The Barcelona Clinic Liver Cancer (BCLC) classification has been regarded as the optimal staging system and treatment algorithm for HCC. However, even in patients with intermediate or advanced stage in BCLC classification, who had not been originally recommended to undergo surgery, some could benefit in terms of long-term survival by surgical treatments. An expert panel on HCC has stated that the American Joint Committee on Cancer staging system, whose predictive power on the outcome have been improved by continuous amendments, should be applied for patients undergoing surgery. Herein, we review the recent staging system focusing on patients with HCC undergoing surgery.   This review contains 5 figures, 3 tables and 34 references Key Words: American Joint Committee on Cancer, Barcelona Clinic Liver Cancer, hepatic resection, hepatocellular carcinoma, orthotopic liver transplantation

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