Modified CLIP score with albumin-bilirubin grade in relation to prognostic value in HBV-related hepatocellular carcinoma patients treated with transcatheter arterial chemoembolization therapy.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 480-480
Author(s):  
Xiu-Rong Cai ◽  
Zhan-Hong Chen ◽  
Qu Lin ◽  
Min Dong ◽  
Xiao-kun Ma ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Value ◽  
Information Criterion ◽  
Roc Curves ◽  
Hepatic Function ◽  
Tnm Staging ◽  
Ratio Test ◽  
Tnm System ◽  
Staging Systems ◽  
Hepatic Function Reserve

480 Background: Child-Pugh grade is widely used to assess hepatic function reserve, but it is relatively subjective for assessment of hepatic encephalopathy. A newly developed scoring system combining albumin and bilirubin, called ALBI grade, aims to assess liver function objectively. In prognosis prediction of hepatocellular carcinoma (HCC), The Cancer of the Liver Italian Program (CLIP) score is commonly used in clinical practice and includes Child-Pugh evaluation. We substituted ALBI grade for Child-Pugh grade to establish ALBI-CLIP system and conducted this study to validate the prognostic value of ALBI -CLIP in HBV-related HCC patients after TACE therapy. Methods: We retrospectively analyzed HBV-related HCC patients who received TACE therapy. Baseline data were collected and evaluated. Child-Pugh grade and ALBI grade were integrated into CLIP and ALBI-CLIP systems, respectively. Univariate and multivariate analyses were conducted to identify independent prognostic factors for overall survival. Comparisons of receiver operating characteristic (ROC) curves and likelihood ratio test (LRT) were used to compare the value of ALBI-CLIP, CLIP and TNM staging systems in predicting survival. Results: A total of 207 patients were included. 153 (73.9%) and 54 (26.1%) patients were classified as Child-Pugh grade A and B, respectively. But according to ALBI grade, 57 (27.5%), 136 (65.7%) and 14 (6.8%) of them were correspondingly divided into Grade 1, 2 and 3. Comparisons of ROC curves showed that ALBI-CLIP and CLIP had similar areas under the curve, both of which were larger than that of TNM system in predicting 3-month, 6-month, 1-year and 2-year survival. LRT indicated that both ALBI-CLIP and CLIP had larger χ2 values and smaller values of Akaike information criterion (AIC), compared with TNM system (χ2 = 29.771, 29.479, 9.105; AIC = 858.215, 858.069, 879.410 for ALBI-CLIP, CLIP and TNM, respectively). Conclusions: Our current study suggested that modified CLIP score with albumin-bilirubin grade retained prognostic value in HBV-related HCC treated with TACE therapy.

scholarly journals Prognostic value of hepatocellular carcinoma staging systems: a comparison

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S72
Author(s):  
S. Bergstresser ◽  
P. Li ◽  
K. Vines ◽  
B. Comeaux ◽  
J. Zarzour ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Value ◽  
Staging Systems

Classification of Lymph Node Metastases from Gastric Cancer: Comparison between N-Site and N-Number Systems. Our Experience and Review of the Literature

2007 ◽  
Vol 73 (4) ◽  
pp. 359-366 ◽  
Author(s):  
Paolo Aurello ◽  
Francesco D'Angelo ◽  
Simone Rossi ◽  
Riccardo Bellagamba ◽  
Claudia Cicchini ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Prognostic Value ◽  
Subtotal Gastrectomy ◽  
Tnm Staging ◽  
The Other ◽  
Tnm System ◽  
Node Metastasis ◽  
Number Systems ◽  
Node Location

The tumor, node, metastasis (TNM) system has become the principal method for assessing the extent of disease, determining prognosis in gastric cancer patients, and affecting the therapy strategies. The extent of lymph node metastasis is the most important prognostic factor. The aim of this study was to compare the N-classifications of the 4th and the 5th-6th TNM editions and to evaluate retrospectively the prognostic value of the 2002 TNM edition. We evaluated 344 patients who underwent curative total or subtotal gastrectomy. Nodal involvement was detected in 221 (64%) patients. Median follow-up period was 76 months. Thirty per cent of the old N1 patients were reclassified as pN2 (18.5%) and pN3 (11.3%). Eighty-eight per cent of the old N2 patients were reclassified as pN1 (75%) and pN3 (13.7%). In reclassifying the patients, statistically significant changes were reported between 1987 and 2002 TNM stage grouping, mainly in stage IIIB and IV. The 5-year survival rate per stage group did not statistically differ between the 4th and the 5th–6th editions, although a diminutive trend was registered in the IIIA stage. pTNM stage, nodal numerical stage, nodal topographical stage, and depth of tumor invasion resulted in significantly independent prognostic factors. Our data confirm the simplicity and easy application of the new stadiation and the better prognostic stratification of the N-stage. The pN3 group showed a worse prognosis independent of location. On the other hand, prognostic value of pN1 and pN2 stage is lower, probably depending on lymph node location. In multivariate analysis, the difference between old and new TNM staging is low. Hence, we suggest comparing lymph node location and number in larger series. In our series, in pT1 tumors, neither pN2 nor pN3 involvement was found. Hence, in our opinion, for correct N-staging, 10 lymph nodes in early gastric cancer and at least 16 in the other pT-stages seem sufficient for a real pN0 stadiation.

scholarly journals Albumin-to-Alkaline Phosphatase Ratio: A Novel Prognostic Index for Hepatocellular Carcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Anthony W. H. Chan ◽  
Stephen L. Chan ◽  
Frankie K. F. Mo ◽  
Grace L. H. Wong ◽  
Vincent W. S. Wong ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Alkaline Phosphatase ◽  
Blood Test ◽  
Prognostic Significance ◽  
Palliative Therapy ◽  
Prognostic Index ◽  
Hepatic Function ◽  
Routine Blood ◽  
Routine Blood Test ◽  
Staging Systems

Prognosis of patients with hepatocellular carcinoma (HCC) depends on both tumour extent and hepatic function reserve. Liver function test (LFT) is a basic routine blood test to evaluate hepatic function. We first analysed LFT components and their associated scores in a training cohort of 217 patients who underwent curative surgery to identify LFT parameters with high performance (discriminatory capacity, homogeneity, and monotonicity of gradient). We derived a novel index, albumin-to-alkaline phosphatase ratio (AAPR), which had the highest c-index (0.646) andχ2(24.774) among other liver biochemical parameters. The AAPR was an independent prognostic factor for overall and disease-free survival. The adjusted hazard ratio of death and tumour relapse was 2.36 (P=0.002) and 1.85 (P=0.010), respectively. The independent prognostic significance of AAPR on top of 5 commonly used and well established staging systems was further confirmed in 2 independent cohorts of patients receiving surgical resection (n=256) and palliative therapy (n=425). In summary, the AAPR is a novel index readily derived from a simple low-cost routine blood test and is an independent prognostic indicator for patients with HCC regardless of treatment options.

Abstract 15571: Echocardiographic Characteristics and Their Association With Outcome in Hospitalized Covid-19 Patients With Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yuman Li ◽  
Lingyun Fang ◽  
Shuangshuang Zhu ◽  
Yuji Xie ◽  
Bin Wang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Prognostic Value ◽  
Troponin I ◽  
Systolic Pressure ◽  
High Sensitivity ◽  
Information Criterion ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Ratio Test ◽  
Echocardiographic Parameters

Background: Echocardiographic characteristics and the prognostic value of echocardiographic parameters in COVID-19 patients with cardiovascular disease (CVD) remain unclear. Objectives: We aimedto describe and compare echocardiographic characteristics of hospitalized COVID-19 patients with and without CVD, and explore the prognostic value of echocardiographic parameters in COVID-19 patients with CVD. Methods: 157 consecutive hospitalized COVID-19 patients were enrolled in our study. Left ventricular (LV) and right ventricular (RV) structure and function were assessed using bedside echocardiography. Results: 89 (56.7 %) patients had underlying CVD.Compared with patients without CVD, those with CVD were more likely to havehigher levels of high-sensitivity troponin I (hs-TNI) and B-type natriuretic peptide, and higher incidence of ARDS, acute heart injury and deep vein thrombosis. During hospitalization, 23(14.6%) patients died. Mortality was significantly higher in CVD compared with non-CVD patients (22.5% vs. 4.4%, p =0.002). CVD patients had increased mitral E/e’, lower tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC), and higher pulmonary artery systolic pressure. TAPSE, RVFAC and elevated hs-TNI level were independent predictors of higher mortality.Furthermore, we found the incremental prognostic value of TAPSE over RVFAC and clinical parameters in COVID-19 patients with CVD using a likelihood ratio test, Akaike information criterion and C-index. Conclusions: COVID-19 patients with CVD displayed impaired cardiac function, which is associated with higher mortality. The additional prognostic value of TAPSE over the other clinical and echocardiographic parameters indicate that TAPSE measurement may be important for risk stratification in COVID-19 patients with CVD.

Myeloid deprived suppressive cell to mediate the prognostic value of neutrophil to hemoglobin ratio for hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 292-292
Author(s):  
Xing Li ◽  
Quan Yang ◽  
Zhi-Huan Lin ◽  
Yingfen Hong ◽  
Yu-Feng Liu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Value ◽  
Mononuclear Cells ◽  
Transcatheter Arterial Chemoembolization ◽  
Statistical Significance ◽  
Score System ◽  
Neutrophil Lymphocyte Ratio ◽  
Cell Counts ◽  
Staging Systems ◽  
Arterial Chemoembolization

292 Background: The prognosis of hepatocellular carcinoma (HCC) patients receiving transcatheter arterial chemoembolization (TACE) is far from being identified. The present study aimed to assess role of blood cell counts, routine liver function tests and neutrophil to hemoglobin ratio (NHR) in predicting the progression-free survival (PFS) of these patients. Methods: A total of 243 HCC patients receiving TACE were analyzed retrospectively. Results: Cancer of the Liver Italian Program (CLIP) score system was identified to be the best score system among current 12 staging systems for this patient subgroup according akaike information criterion (AIC) index and linear trend χ2. Then, the novel prognostic value of parameters was determined by integration into CLIP score system. As a result, NHR were confirmed to an independent predictor for PFS of HCC patients receiving TACE (p = 0.001) with the other parameters, including neutrophil and neutrophil-lymphocyte ratio (NLR), failed to reach statistical significance. Moreover, NHR improved the performance of CLIP by adjusted into it, thus improved the discriminatory ability. Furthermore, NHR were defined value ≤ 0.02 as low level and > 0.02 as high level, according to which patients were dichotomized into two groups. HCC patients receiving TACE with low NHR presented higher 1 year disease control rate (DCR) (50.0% vs 39.35%) and 2 year DCR (45.4% vs 27.0%) compared with patients with high NHR level. Besides, NHR level was associated with prognostic factors such as portal vein thrombosis and distant metastasis. Furthermore, in order to determine the mechanism of predictive value of AHR, we tested the proportion of myeloid deprived suppressive cell (MDSC) in peripheral blood mononuclear cells (PBMC) of 43 HCC patients. It was revealed that MDSC was positively correlated with neutrophil (P< 0.05). Since MDSC was cancer promoter, it might be the mechanism of the prognostic value of NHR. Conclusions: The present study firstly identified NHR as an independent prognostic factor in HCC patients receiving TACE. The positive correlation of MDSC and neutrophil might be the latent mechanism.

Prognostic value of serum apolipoprotein B (ApoB) to apolipoprotein A-I (ApoA-I) ratio in hepatocellular carcinoma patients with transcatheter arterial chemoembolization treatment: propensity score-matched analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14589-e14589
Author(s):  
Meng meng Liu ◽  
Zhan-Hong Chen ◽  
Yu-tong Chen ◽  
Zi-xian Wang ◽  
Xiangyuan Wu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Propensity Score ◽  
Distant Metastasis ◽  
Prognostic Value ◽  
Transcatheter Arterial Chemoembolization ◽  
Prognostic Index ◽  
Receiver Operating Curve ◽  
Tnm System ◽  
Arterial Chemoembolization

e14589 Background: The aim of our research was to assess the prognostic value of ApoB to ApoA-I ratio (ApoB/ApoA-I) in hepatocellular carcinoma (HCC) patients with transcatheter arterial chemoembolization (TACE) treatment. Methods: We collected clinicopathological data of 455 HCC patients with TACE treatments. The cutoff value of ApoB/ApoAI identified by receiver-operating curve (ROC) was 0.56. Correlation analysis was carried out to explore the relationship among ApoB/ApoA-I and other clinicopathological variables. Propensity score-matched (PSM) analysis was carried out to eliminate the unbalance of baseline characteristics of high and low ApoB/ApoA-I group. Finally, 278 patients were included in the PSM cohort, 139 patients in the high APOB/APOA-I group and 139 patients in the low APOB/APOA-I group. Univariate and multivariate analysis were conducted to explore the independent prognostic value of ApoB/ApoA-I in 455 patients and in the PSM cohort. Results: ApoB/ApoA-I was significantly correlated with AFP, NCCN T stage, distant metastasis status and TNM system(P < 0.05). Patients with AFP≥400ng, T3-4, distant metastasis and TNM III-IV had significantly higher serum ApoB/ApoA-I level than that of patients with AFP ≥ 400 ng/ml, T1-2, without metastasis and TNM I-II(P <0.05). Patients in high ApoB/ApoA-I group had significantly shorter overall survival compared to those in low ApoB/ApoA-I group in 455 HCC patients and in the PSM cohort (P < 0.01). Multivariate analysis indicated that ApoB/ApoA-I was an independent prognostic index for OS in 455 HCC patients and the PSM cohort (HR = 1.443, P = 0.006; HR = 1.564, P = 0.006, respectively.) Conclusions: Serum ApoB/ApoA-I is a novel independent prognostic factor for the HCC patients treated with TACE.

scholarly journals Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Liver Cancer ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 126-136
Author(s):  
Claudia Campani ◽  
Alessandro Vitale ◽  
Gabriele Dragoni ◽  
Umberto Arena ◽  
Giacomo Laffi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Prognostic Scores ◽  
Prognostic Models ◽  
Independent Effect ◽  
Ratio Test ◽  
Time Varying ◽  
Staging Systems

<b><i>Introduction:</i></b> The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). <b><i>Methods:</i></b> An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. <b><i>Results:</i></b> The median OS of the enrolled patients was 41 months. According to LRT χ<sup>2</sup> and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, <i>p</i> &#x3c; 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, <i>p</i> &#x3c; 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. <b><i>Conclusion:</i></b> An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

scholarly journals Redefining Hepatocellular Carcinoma Staging Systems Based on the Bile Duct Invasion Status: A Multicenter Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Qizhen Huang ◽  
Yufeng Chen ◽  
Kongying Lin ◽  
Chuandong Sun ◽  
Shuguo Zheng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Liver Cancer ◽  
Prognostic Value ◽  
Predictive Performance ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Staging Systems ◽  
Bile Duct Invasion ◽  
Cox Proportional Hazard Regression

Background and AimsThe prognostic value of bile duct invasion (BDI) remains controversial. We aimed to investigate the prognostic value of BDI and the stage of BDI in different staging systems.MethodsPatients with hepatocellular carcinoma (HCC) from nine hepatobiliary medical centers who underwent R0 resection were included. Overall survival (OS) was assessed using the Kaplan–Meier method and tested using the log-rank test. The prognostic effect of BDI was analyzed using univariate and multivariate Cox proportional hazard regression analyses. The predictive performance of these models was evaluated using the concordance index and time-dependent receiver operating characteristic curve (tdAUC).ResultsOf 1021 patients with HCC, 177 had BDI. OS was worse in the HCC with BDI group than in the HCC without BDI group (p&lt;0.001); multivariate analysis identified BDI as an independent risk factor for OS. After adjustment for interference of confounding factors using the Cox proportional hazard regression model, HCC with BDI and without macrovascular invasion was classified as Barcelona Clinic Liver Cancer (BCLC) B, eighth edition American Joint Committee on Cancer (AJCC) IIIA, and China Liver Cancer (CNLC) IIb, respectively, whereas HCC with BDI and macrovascular was classified as BCLC C, AJCC IIIB, and CNLC IIIA, respectively. C-indexes and tdAUCs of the adjusted staging systems were superior to those of the corresponding current staging systems.ConclusionWe constructed adjusted staging systems with the BDI status, improved their predictive performance and facilitate clinical use.

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]

Prognostic Factors in Adenocarcinoma of the Esophagus or Gastroesophageal Junction

2006 ◽  
Vol 24 (26) ◽  
pp. 4347-4355 ◽  
Author(s):  
Sjoerd M. Lagarde ◽  
Fiebo J.W. ten Kate ◽  
Johannes B. Reitsma ◽  
Olivier R.C. Busch ◽  
J. Jan B. van Lanschot
Keyword(s):  
Prognostic Factors ◽  
Western Europe ◽  
Gastroesophageal Junction ◽  
Staging System ◽  
Preoperative Chemoradiotherapy ◽  
Tnm Staging ◽  
Prognostic Impact ◽  
Adenocarcinoma Of The Esophagus ◽  
Tnm System ◽  
Staging Systems

The incidence of adenocarcinoma of the esophagus is rising rapidly in Western Europe and North America. It is an aggressive disease with early lymphatic and hematogenous dissemination. TNM cancer staging systems predict survival on the basis of the anatomic extent of the tumor. However, the adequacy of the current TNM staging system for adenocarcinoma of the esophagus or gastroesophageal junction (GEJ) is questioned repeatedly. Numerous prognostic factors have been described, but are not included in the TNM system. This review describes clinical parameters, aspects of operative technique, response to preoperative chemoradiotherapy therapy, complications and established pathologic determinants found in the resection specimen that have a prognostic impact. Furthermore, their potential application in the clinical setting in patients with adenocarcinoma of the esophagus or GEJ is discussed. Future directions to improve staging systems are given.

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