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

  • Tian Yang
  • Jin Zhang
  • Jun-Hua Lu
  • Li-Qun Yang
  • Guang-Shun Yang
  • Meng-Chao Wu
  • Wei-Feng Yu
Original Paper

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.

Keywords

Hepatocellular carcinoma Staging Surgical resection 

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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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tian Yang
    • 1
  • Jin Zhang
    • 1
  • Jun-Hua Lu
    • 1
  • Li-Qun Yang
    • 2
  • Guang-Shun Yang
    • 1
  • Meng-Chao Wu
    • 1
  • Wei-Feng Yu
    • 1
    • 2
  1. 1.Department of 2nd Hepatobiliary Surgery, Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityYangpu District, ShanghaiChina
  2. 2.Intensive Care Unit, Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina

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