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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Barcelona clinic liver cancer nomogram and others staging/scoring systems in a French hepatocellular carcinoma cohort
Xavier Adhoute, Guillaume Pénaranda, Jean Luc Raoul, Julien Edeline, Jean-Frédéric Blanc, Bernard Pol, Manuela Campanile, Hervé Perrier, Olivier Bayle, Olivier Monnet, Patrick Beaurain, Cyril Muller, Paul Castellani, Yves Patrice Le Treut, Jean Pierre Bronowicki, Marc Bourlière
Xavier Adhoute, Hervé Perrier, Paul Castellani, Marc Bourlière, Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, 13008 Marseille, France
Guillaume Pénaranda, AlphaBio Laboratory Marseille, 13012 Marseille, France
Jean Luc Raoul, Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette Marseille, 13009 Marseille, France
Julien Edeline, Department of Hepato-Gastroenterology and Digestive Oncology, Centre Eugène Marquis Rennes, 35000 Rennes, France
Jean-Frédéric Blanc, Department of Hepato-Gastroenterology, Centre Hospitalo-Universitaire Saint-André Bordeaux, 33000 Bordeaux, France
Bernard Pol, Manuela Campanile, Department of Hepatobiliary Surgery, Hôpital Saint-Joseph Marseille, 13008 Marseille, France
Olivier Bayle, Olivier Monnet, Patrick Beaurain, Cyril Muller, Department of Radiology, Hôpital Saint-Joseph Marseille, 13008 Marseille, France
Yves Patrice Le Treut, Department of Hepatobiliary Surgery, Centre Hospitalo-Universitaire Timone Marseille, 13000 Marseille, France
Jean Pierre Bronowicki, Department of Hepato-Gastroenterology, Centre Hospitalo-Universitaire de Nancy, 54000 Nancy, France
Jean Pierre Bronowicki, INSERM U954, Université de Lorraine, CHU de Nancy, Vandoeuvre les Nancy, 54000 Nancy, France
Author contributions: Adhoute X, Raoul JL, Edeline J, Blanc JF, Perrier H, Castellani P, Bronowicki JP and Bourlière M are physicians in charge of the patients; Bayle O, Monnet O, Beaurain P, Muller C are radiologists who make TACE; Pol B, Campanile M, Le Treut YP are the liver surgeon involved in patients’ treatments; Adhoute X, Edeline J, Blanc JF, Bronowicki JP collected the data and Pénaranda G have proceeded to statistical analysis; Adhoute X, Pénaranda G, Raoul JL and Bourlière M wrote the manuscript.
Institutional review board statement: The study was reviewed and approved by the Hôpital Saint - Joseph Institutional Review Board.
Informed consent statement: It is a retrospective series; the ethics committee of our institution (Hôpital-Saint-Joseph) has given us permission for this work.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Xavier Adhoute, Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, 26 Bd de Louvain, Marseille 13008, France. adhoute.xavier@neuf.fr
Telephone: +33-491-806500 Fax: +33-491-806500
Received: December 28, 2016
Peer-review started: December 29, 2016
First decision: February 10, 2017
Revised: February 27, 2017
Accepted: March 21, 2017
Article in press: March 21, 2017
Published online: April 14, 2017
AIM
To compare the performances of the Barcelona clinic liver cancer (BCLC) nomogram and others systems (BCLC, HKLC, CLIP, NIACE) for survival prediction in a large hepatocellular carcinoma (HCC) French cohort.
METHODS
Data were collected retrospectively from 01/2007 to 12/2013 in five French centers. Newly diagnosed HCC patients were analyzed. The discriminatory ability, homogeneity ability, prognostic stratification ability Akaike information criterion (AIC) and C-index were compared among scoring systems.
RESULTS
The cohort included 1102 patients, mostly men, median age 68 [60-74] years with cirrhosis (81%), child-Pugh A (73%), alcohol-related (41%), HCV-related (27%). HCC were multinodular (59%) and vascular invasion was present in 41% of cases. At time of HCC diagnosis BCLC stages were A (17%), B (16%), C (60%) and D (7%). First line HCC treatment was curative in 23.5%, palliative in 59.5%, BSC in 17% of our population. Median OS was 10.8 mo [4.9-28.0]. Each system distinguished different survival prognosis groups (P < 0.0001). The nomogram had the highest discriminatory ability, the highest C-index value. NIACE score had the lowest AIC value. The nomogram distinguished sixteen different prognosis groups. By classifying unifocal large HCC into tumor burden 1, the nomogram was less powerful.
CONCLUSION
In this French cohort, the BCLC nomogram and the NIACE score provided the best prognostic information, but the NIACE could even help treatment strategies.
Core tip: Barcelona clinic liver cancer (BCLC) nomogram was compared with BCLC, HKLC systems, CLIP, and NIACE scores for survival prediction in a HCC French cohort. 1102 patients were retrospectively included, with cirrhosis (81%), child-Pugh A (73%). Hepatocellular carcinoma (HCC) were multinodular (59%) and with vascular invasion (41%). At time of HCC diagnosis, patients were mainly BCLC-C (60%). First line HCC treatment was curative (23.5%) or palliative (59.5%). Median OS was 10.8 mo [4.9-28.0]. BCLC nomogram had the highest discriminatory ability, the highest C-index value. NIACE score had the lowest akaike information criterion value. In this French cohort, BCLC nomogram and NIACE score provided the best prognostic information.
