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A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort

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Abstract

Purpose

Surgical resection remains the gold standard for hepatocellular carcinoma (HCC). Although various staging systems have been developed in recent years, the best tool for staging of HCC remains controversial. The aims of this study were to establish a new staging for patients with HCC undergoing surgical resection and to indentify whether this staging is superior to other staging systems in predicting survival of resectable HCC.

Methods

The subjects of this retrospective study were 958 consecutive HCC patients who underwent surgical resection between 2000 and 2006. Predictors of survival were identified using the Kaplan–Meier method and the Cox model. The disease state was staged by our proposed Eastern staging system by integrating independent risk predictors, as well as six existing staging systems. The accuracy of prediction of 1-, 3-, and 5-year mortality for each system was evaluated by the area under the receiver operating characteristic curve (AUC).

Results

Macroscopic vascular invasion, multiple tumors, performance status 1–2, microscopic vascular invasion, extrahepatic spread, tumor size > 5 cm, albumin < 35 g/L, aspartate aminotransferase > 40 U/L, total bilirubin > 17 μmol/L, and presence of cirrhosis were identified as independent risk factors of survival after resection by multivariate analysis. The comparison of the results of the different staging systems showed that our Eastern staging had the best homogeneity (likelihood ratio χ2 test 543.51, P < 0.001), monotonicity of gradients (linear trend χ2 test 414.97, P < 0.001), and discriminatory ability (the highest AUCs for 1-, 3-, and 5-year mortality).

Conclusions

Compared with other existing staging systems, our proposed Eastern staging system shows a superior predictive ability in a Chinese cohort of patients with resectable HCC, and it can give important prognostic information after surgery.

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Abbreviations

HCC:

Hepatocellular carcinoma

HBV:

Hepatitis B virus

AJCC:

American Joint Committee on Cancer Staging

TNM:

Tumor node metastasis

CLIP:

Cancer of Liver Italian Program

BCLC:

Barcelona Clinic Liver Cancer

CUPI:

Chinese University Prognostic Index

JIS:

Japanese Integrated System

ECOG:

Eastern Cooperative Oncology Group

PEI:

Percutaneous ethanol injection

AFP:

Alpha-fetoprotein

TACE:

Transarterial chemoembolization

ROC:

Receiver operating characteristic

AUC:

Area under curve

HCV:

Hepatitis C virus

PVT:

Portal vein thrombosis

TB:

Total bilirubin

ALB:

Albumin

AST:

Aspartate aminotransferase

LR:

Likelihood ratio

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Authors and Affiliations

  1. Department of 2nd Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai, China

    Tian Yang, Jin Zhang, Jun-Hua Lu, Guang-Shun Yang, Meng-Chao Wu & Wei-Feng Yu

  2. Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Li-Qun Yang & Wei-Feng Yu

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  1. Tian Yang
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  2. Jin Zhang
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  3. Jun-Hua Lu
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  4. Li-Qun Yang
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  5. Guang-Shun Yang
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  7. Wei-Feng Yu
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Correspondence to Wei-Feng Yu.

Additional information

T. Yang, J. Zhang, and J.-H. Lu contributed equally to this work.

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Yang, T., Zhang, J., Lu, JH. et al. A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort. J Cancer Res Clin Oncol 137, 739–750 (2011). https://doi.org/10.1007/s00432-010-0935-3

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  • DOI: https://doi.org/10.1007/s00432-010-0935-3

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