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.

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]

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.

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

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

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

scholarly journals The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

2020 ◽  
Author(s):  
Shuxin Sun ◽  
Chaobin He ◽  
Jun Wang ◽  
Xin Huang ◽  
Jiali Wu ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Prognostic Score ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Prognostic Nutritional Index ◽  
Significant Prognostic Factor ◽  
Entire Cohort ◽  
Lymphocyte Ratio ◽  
Survival Differences

Abstract Background Growing evidence indicates that systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with the clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of the inflammatory indexes in patients suffering from ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD). Methods We retrospectively reviewed a database of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value of survival. The survival differences of these indexes were compared by Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of progress-free survival (PFS) and overall survival (OS). Results The estimated 1-, 2-, and 3-year OS and PFS rates were 83.9%, 65.8%, 55.2% and 58.0%, 42.8%, 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and PFS when they were stratified by these inflammation-based indexes. The comparisons of AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed highest prognostic value, compared to other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor in terms of OS and PFS. Conclusion Specific inflammatory indexes, such as NLR, PLR and PI, were found to be able to predict the OS or PFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting prognosis of patients with AC after PD procedure.

Transition of molecular target agent therapy in advanced hepatocellular carcinoma: A multicenter, retrospective study.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 317-317
Author(s):  
Kazufumi Kobayashi ◽  
Sadahisa Ogasawara ◽  
Aya Takahashi ◽  
Yuya Seko ◽  
Satoshi Tsuchiya ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Study ◽  
Performance Status ◽  
Progression Free Survival ◽  
Staging System ◽  
Sequential Therapy ◽  
Molecular Target ◽  
Advanced Hepatocellular Carcinoma ◽  
Entire Cohort ◽  
Significant Difference

317 Background: There have been considerable advances in systemic chemotherapy for hepatocellular carcinoma (HCC) in recent times. Currently, four molecular target agents (MTA) are available for HCC treatment in Japan. Sequential therapy using multiple MTAs is being considered as the gold standard of treatment. However, the effectiveness of the treatment strategy transition for HCC remains unclear. The present study aimed to clarify the current practical use of MTAs and its effectiveness in HCC treatment. Methods: In this multicenter, retrospective study, we collected and analyzed the clinical data of 877 patients who underwent MTA therapy for HCC from June 2009 to March 2019 at several institutes in Japan. The patients were classified into 3 groups as per the period of initial MTA treatment beginning (period 1: 2009–2012, n = 267; period 2: 2013–2016, n = 352; period 3: 2017–2019, n = 258). These 3 periods were defined to have approximately same term. Period 3 means the era of multiple MTAs because of the approval of regorafenib in Japan in 2017. We assessed the patient characteristics, MTA use, and prognosis of the 3 groups. Results: The proportion of patients with advanced-stage HCC, defined according to the Barcelona Clinic Liver Cancer staging system, in each period was 70.1%, 66.5%, and 62.0% in period 1, 2, and 3, respectively. MTA use for intermediate stages increased with the passage of time ( p = 0.052). The proportion of multiple MTAs use was remarkably increased in the 3 groups (1.1%, 10.2%, and 42.6%, respectively, p < 0.0001). Child-Pugh score, proportion of macrovascular invasion, extrahepatic metastasis, and α-fetoprotein (AFP) ≥400 ng/mL showed no significant difference among the 3 groups. The median overall survival was 11.9 months for the entire cohort and 10.4, 11.3, and 15.2 months, for period 1, 2, and 3, respectively. It is noteworthy that the prognosis of patients with HCC improved over time ( p = 0.016). With respect to progression-free survival, the median value was 3.0 months for the entire cohort and 2.7, 2.8, and 4.7 months for period 1, 2, and 3, respectively ( p < 0.0001). The treatment duration was also prolonged with time (2.7, 3.2, and 6.6 months for period 1, 2, and 3, respectively; p < 0.0001). Multivariate analysis using Cox proportional hazard model showed that HCV infection, Child-Pugh score, performance status, α-fetoprotein ≥400 ng/mL, presence of macrovascular invasion, and period 3 for initial MTA introduction were independent prognostic factors. Conclusions: Sequential therapy with multiple MTAs has gained popularity with time and is considered to improve patient prognosis. The development of MTA therapy for HCC is expected to continue. Therefore, further studies are needed to help determine the appropriate drugs, the sequence of MTA use, and the precise transition time.

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