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Jin Y, Liang ZY, Zhou WX, Zhou L. An MMP-based risk score strongly distinguishes prognosis in hepatocellular carcinoma after resection. Future Oncol 2022; 18:2903-2917. [PMID: 35861053 DOI: 10.2217/fon-2021-1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To first explore the prognostic value of MMP11 and MMP15 in hepatocellular carcinoma. Methods: MMP11/MMP15 expression was immunohistochemically detected and correlated with clinicopathologic variables and survival and confirmed in publicly available databases. An MMP-based risk score (MMPRS) was established. Results: Tumoral MMP11/MMP15 expression was higher and univariately associated with crucial clinicopathologic parameters, overall survival and disease-free survival in all patients and/or many subsets. Multivariately, MMP11/MMP15 expression remained significant. Their overexpression and prognostic value were confirmed in the Ualcan and Kaplan-Meier plotter databases. Critically, the novel MMPRS integrating MMP11, MMP15 and tumor-node-metastasis stage identified subgroups with the best and worst prognoses, with much higher predictive power. Conclusion: MMP11 and MMP15 served as prognosticators in hepatocellular carcinoma. MMPRS might work more accurately.
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Affiliation(s)
- Ye Jin
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100730, China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100730, China
| | - Wei-Xun Zhou
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100730, China
| | - Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100730, China
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Beumer BR, Buettner S, Galjart B, van Vugt JLA, de Man RA, IJzermans JNM, Koerkamp BG. Systematic review and meta-analysis of validated prognostic models for resected hepatocellular carcinoma patients. Eur J Surg Oncol 2021; 48:492-499. [PMID: 34602315 DOI: 10.1016/j.ejso.2021.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many prognostic models for Hepatocellular Carcinoma (HCC) have been developed to inform patients and doctors about individual prognosis. Previous reviews of these models were qualitative and did not assess performance at external validation. We assessed the performance of prognostic models for HCC and set a benchmark for biomarker studies. METHODS All externally validated models predicting survival for patients with resected HCC were systematically reviewed. After selection, we extracted descriptive statistics and aggregated c-indices using meta-analysis. RESULTS Thirty-eight validated prognostic models were included. Models used on average 7 (IQR:4-9) prognostic factors. Tumor size, tumor number, and vascular invasion were almost always included. Alpha-fetoprotein (AFP) was commonly incorporated since 2007. Recently, the more subjective items ascites and encephalopathy have been dropped. Eight established models performed poor to moderate at external validation, with a pooled C-index below 0.7; including the Barcelona Clinic Liver Cancer (BCLC) system, the American Joint Committee on Cancer (AJCC) 7th edition, the Cancer of the Liver Italian (CLIP) Program, and the Japan Integrated Staging (JIS) score. Out of 24 prognostic models predicting OS, only 6 (25%) had good performance at external validation with pooled C-indices above 0.7; the Li-post (0.77), Li-OS (0.74), Yang-pre (0.74), Yang-post (0.76), Shanghai-score (0.70), and Wang-nomogram (0.71). Models improved over time, but overall performance and study quality remained low. CONCLUSIONS Six validated prognostic models demonstrated good performance for predicting survival after resection of HCC. These models can guide patients and doctors and are a benchmark for future models incorporating novel biomarkers.
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Affiliation(s)
- Berend R Beumer
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Stefan Buettner
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Boris Galjart
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jeroen L A van Vugt
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Robert A de Man
- Erasmus MC Transplant Institute, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jan N M IJzermans
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
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Vitale A, Farinati F, Finotti M, Di Renzo C, Brancaccio G, Piscaglia F, Cabibbo G, Caturelli E, Missale G, Marra F, Sacco R, Giannini EG, Trevisani F, Cillo U. Overview of Prognostic Systems for Hepatocellular Carcinoma and ITA.LI.CA External Validation of MESH and CNLC Classifications. Cancers (Basel) 2021; 13:1673. [PMID: 33918125 PMCID: PMC8037197 DOI: 10.3390/cancers13071673] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.
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Affiliation(s)
- Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (A.V.); (F.F.); (C.D.R.); (U.C.)
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (A.V.); (F.F.); (C.D.R.); (U.C.)
| | - Michele Finotti
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (A.V.); (F.F.); (C.D.R.); (U.C.)
| | - Chiara Di Renzo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (A.V.); (F.F.); (C.D.R.); (U.C.)
| | - Giuseppina Brancaccio
- Infectious Diseases Unit, Department of Internal Medicine, Padua University Hospital, 35123 Padua, Italy;
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, 90127 Palermo, Italy;
| | | | - Gabriele Missale
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy;
| | - Fabio Marra
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Firenze, 50139 Firenze, Italy;
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71122 Foggia, Italy;
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Franco Trevisani
- Division of Semeiotics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (A.V.); (F.F.); (C.D.R.); (U.C.)
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Noda C, Williams GA, Foltz G, Kim H, Sanford DE, Hammill CW, Fields RC. The safety of hepatectomy after transarterial radioembolization: Single institution experience and review of the literature. J Surg Oncol 2020; 122:1114-1121. [PMID: 32662066 DOI: 10.1002/jso.26115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The liver is a frequent site of malignancy, both primary and metastatic. The treatment goal of patients with liver cancer may include transarterial radioembolization (TARE). There are limited reports on the safety of hepatectomy following TARE. Our study's purpose is to review patients who have received TARE followed by hepatectomy. METHODS A retrospective study was performed on patients diagnosed with any liver cancer from 2013 to 2019 who underwent TARE followed by hepatectomy. Postoperative complications were prospectively collected. Descriptive statistics and the Kaplan-Meier test were used to assess survival outcomes. RESULTS Twelve patients were treated with a TARE followed by a hepatectomy (nine with ≥4 segments resected). Diagnoses included: six HCC, four cholangiocarcinoma, one metastatic neuroendocrine tumor, and one metastatic colorectal cancer. There were no 90-day post-hepatectomy mortalities and the overall morbidity was 66% (16% severe ≥MAGS 3). Hepatectomy-specific complications after hepatectomy included two (16%) bile leaks and no post-hepatectomy liver failures. The median recurrence free survival was 26 months. Overall survival at 1-year was 78% and at 3 years was 47%. CONCLUSIONS Our results support the safety of hepatectomy in select patients after TARE. Additional comparison to patients who receive hepatectomy as a first-line treatment for liver cancers should be investigated.
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Affiliation(s)
- Christopher Noda
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gretchen Foltz
- Department of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Zhang M, Zhang S, Yang Z, Hu J, Hu W, Sun P, Wu L, Han B. Association between the expression levels of IL-6 and IL-6R in the hepatocellular carcinoma microenvironment and postoperative recurrence. Oncol Lett 2018; 16:7158-7165. [PMID: 30546452 PMCID: PMC6256737 DOI: 10.3892/ol.2018.9557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022] Open
Abstract
The tumor microenvironment of hepatocellular carcinoma (HCC) is a complex system, involving mutual promotion and inhibition between cells and molecules. It results in alterations to inflammatory-associated factors, including a decrease in interleukin (IL)-2 and an increase in tumor necrosis factor, together with a characteristic elevation of IL-6. Following the synthesis and release of IL-6, HCC is stimulated through IL-6 binding to the IL-6 receptor (IL-6R). In the present study, immunohistochemistry was performed to investigate the expression levels of IL-6 and IL-6R in 92 patients with HCC, and the association between IL-6/IL-6R expression levels and tumor recurrence was examined. Notably increased expression levels of IL-6 and IL-6R were observed in the HCC microenvironment, and recurrence occurred earlier in patients with high IL-6/IL-6R expression levels compared with those with low expression levels (P<0.05). However, there was no significant difference in overall survival between patients in the two groups (P>0.05). Platelet levels <100×109/l, tumor-node-metastasis stage IIIa and high expression levels of IL-6/IL-6R were independent risk factors for postoperative recurrence (P<0.05). The present study proposed that high IL-6 and IL-6R expression in the HCC microenvironment promotes postoperative tumor recurrence, suggesting that these may be potential predictors of recurrence, and may be used as possible therapeutic targets to enhance the long-term survival of patients.
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Affiliation(s)
- Mao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Shun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Zhenjie Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Jie Hu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410006, P.R. China
| | - Weiyu Hu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Peng Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Liqun Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Bing Han
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
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Koh YX, Tan HL, Lye WK, Kam JH, Chiow AKH, Tan SS, Choo SP, Chung AYF, Goh BKP. Systematic review of the outcomes of surgical resection for intermediate and advanced Barcelona Clinic Liver Cancer stage hepatocellular carcinoma: A critical appraisal of the evidence. World J Hepatol 2018; 10:433-447. [PMID: 29988922 PMCID: PMC6033716 DOI: 10.4254/wjh.v10.i6.433] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/10/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a systematic review to determine the survival outcomes after curative resection of intermediate and advanced hepatocellular carcinomas (HCC). METHODS A systematic review of the published literature was performed using the PubMed database from 1st January 1999 to 31st Dec 2014 to identify studies that reported outcomes of liver resection as the primary curative treatment for Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC. The primary end point was to determine the overall survival (OS) and disease free survival (DFS) of liver resection of HCC in BCLC stage B or C in patients with adequate liver reserve (i.e., Child's A or B status). The secondary end points were to assess the morbidity and mortality of liver resection in large HCC (defined as lesions larger than 10 cm in diameter) and to compare the OS and DFS after surgical resection of solitary vs multifocal HCC. RESULTS We identified 74 articles which met the inclusion criteria and were analyzed in this systematic review. Analysis of the resection outcomes of the included studies were grouped according to (1) BCLC stage B or C HCC, (2) Size of HCC and (3) multifocal tumors. The median 5-year OS of BCLC stage B was 38.7% (range 10.0-57.0); while the median 5-year OS of BCLC stage C was 20.0% (range 0.0-42.0). The collective median 5-year OS of both stages was 27.9% (0.0-57.0). In examining the morbidity and mortality following liver resection in large HCC, the pooled RR for morbidity [RR (95%CI) = 1.00 (0.76-1.31)] and mortality [RR (95%CI) = 1.15 (0.73-1.80)] were not significant. Within the spectrum of BCLC B and C lesions, tumors greater than 10 cm were reported to have median 5-year OS of 33.0% and multifocal lesions 54.0%. CONCLUSION Indication for surgical resection should be extended to BCLC stage B lesions in selected patients. Further studies are needed to stratify stage C lesions for resection.
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Affiliation(s)
- Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore.
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Weng Kit Lye
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Juinn Huar Kam
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Adrian Kah Heng Chiow
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Siong San Tan
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Su Pin Choo
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
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Petrovski S, Karakolevska-Ilova M, Simeonovska-Joveva E, Serafimov A, Adzi-Andov L, Dimitrova V. Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases. Open Access Maced J Med Sci 2018; 6:1046-1051. [PMID: 29983799 PMCID: PMC6026431 DOI: 10.3889/oamjms.2018.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%. AIM: To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients. METHODS: This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases. CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.
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Affiliation(s)
- Stefan Petrovski
- Clinical Hospital Shtip, Surgery, Ljuben Ivanov bb, Shtip, Republic of Macedonia
| | | | | | | | | | - Violeta Dimitrova
- Clinic of General and Hepato-Pancreatic Surgery, University Hospital "Aleksandrovska", Sofia, Bulgaria
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Liu S, Li X, Li H, Guo L, Zhang B, Zhang J, Ye Q. Is the Hong Kong Liver Cancer staging system the best guide for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors? Oncotarget 2018; 7:51598-51607. [PMID: 27323396 PMCID: PMC5239499 DOI: 10.18632/oncotarget.9956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It still must be confirmed whether the newly developed Hong Kong Liver Cancer Staging (HKLC) system can effectively stratify patients with multiple tumors and identify patients who could obtain a survival benefit with radical resection. In this study, we retrospectively compared survival rates of surgery versus transcatheter arterial chemoembolization for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors by using the propensity score method. In addition, the prognostic roles of tumor size, number and thrombus status together with other covariates on postoperative survival were analyzed by multivariate analysis. In matched cohorts, surgical treatment could significantly reduce patient mortality in patients within or outside HKLC criteria (odds ratio (OR) = 0.5, P < 0.001, OR = 0.6, P = 0.001, respectively). In 941 patients undergoing radical resection, the state of tumor thrombus demonstrated a significant interaction with tumor size on postoperative survival (P for interaction = 0.041). Tumor number was not a predictor of postoperative survival in patients with multiple tumors (adjusted OR = 1.1, P = 0.202). In patients without tumor thrombus, tumor size > 5 cm was an independent risk factor of postoperative survival (OR = 1.7, P < 0.001). In patients without tumor thrombus, patient survival was mainly influenced by tumor location (OR = 2.1, P < 0.001). In summary, patients with multiple tumors could obtain a survival benefit from radical surgery based on the more aggressive HKLC staging system. However, parameters in this staging system still need further adjustments.
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Affiliation(s)
- Shuang Liu
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Xiaoqiang Li
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Hui Li
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Lei Guo
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Bo Zhang
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Jubo Zhang
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
| | - Qinghai Ye
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
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Zhao JJ, Yan T, Zhao H, Zhou JG, Huang Z, Zhang YF, Li Y, Li ZY, Bi XY, Cai JQ. Evaluation of eight different clinical staging systems associated with overall survival of chinese patients with hepatocellular carcinoma. Chin Med J (Engl) 2015; 128:316-21. [PMID: 25635426 PMCID: PMC4837861 DOI: 10.4103/0366-6999.150095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Hepatocellular carcinoma (HCC) is a common cancer in China, an area of high hepatitis B virus (HBV) infection. Although several staging systems are available, there is no consensus on the best classification to use because multiple factors, such as etiology, clinical treatment and populations could affect the survival of HCC patients. Methods: This study analyzed 743 HBV-related Chinese HCC patients who received surgery first and evaluated the predictive values of eight different commonly used staging systems in the clinic. Results: The overall 1-, 3-, 5-year survival rates and a median survival were 91.5%, 70.3%, 55.3% and 72 months respectively. Barcelona Clinic Liver Cancer (BCLC) staging systems had the best stratification ability and showed the lowest Akaike information criterion (AIC) values (2896.577), followed by tumor-node-metastasis 7th (TNM 7th) (AIC = 2899.980), TNM 6th (AIC = 2902.17), Japan integrated staging score (AIC = 2918.085), Tokyo (AIC = 2938.822), Cancer of the Liver Italian Program score (AIC = 2941.950), Chinese University Prognostic Index grade (AIC = 2962.027), and Okuda (AIC = 2979.389). Conclusions: BCLC staging system is a better staging model for HBV infection patients with HCC in Chinese population among the eight currently used staging systems. These identifications afford a large group of Chinese HCC patients with HBV infection and could be helpful to design a new staging system for a certain population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jian-Qiang Cai
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Gomaa AI, Al-Khatib A, Abdel-Razek W, Hashim MS, Waked I. Ascites and alpha-fetoprotein improve prognostic performance of Barcelona Clinic Liver Cancer staging. World J Gastroenterol 2015; 21:5654-5662. [PMID: 25987792 PMCID: PMC4427691 DOI: 10.3748/wjg.v21.i18.5654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 12/31/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess how ascites and alpha-fetoprotein (AFP) added to the Barcelona Clinic Liver Cancer (BCLC) staging predict hepatocellular carcinoma survival.
METHODS: The presence of underlying cirrhosis, ascites and encephalopathy, Child-Turcotte-Pugh (CTP) score, the number of nodules, and the maximum diameter of the largest nodule were determined at diagnosis for 1060 patients with hepatocellular carcinoma at a tertiary referral center for liver disease in Egypt. Demographic information, etiology of liver disease, and biochemical data (including serum bilirubin, albumin, international normalized ratio, alanine and aspartate aminotransferases, and AFP) were evaluated. Staging of the tumor was determined at the time of diagnosis using the BCLC staging system; 496 patients were stage A and 564 patients were stage B. Patients with mild ascites on initial ultrasound, computed tomography, or clinical examination, and who had a CTP score ≤ 9 were included in this analysis. All patients received therapy according to the recommended treatment based on the BCLC stage, and were monitored from the time of diagnosis to the date of death or date of data collection. The effect of the presence of ascites and AFP level on survival was analyzed.
RESULTS: At the time the data were censored, 123/496 (24.8%) and 218/564 (38.6%) patients with BCLC stages A and B, respectively, had died. Overall mean survival of the BCLC A and B patients during a three-year follow-up period was 31 mo [95% confidence interval (95%CI): 29.7-32.3] and 22.7 mo (95%CI: 20.7-24.8), respectively. The presence of ascites, multiple focal lesions, large tumor size, AFP level and CTP score were independent predictors of survival for the included patients on multivariate analysis (P < 0.001). Among stage A patients, 18% had ascites, 33% had AFP ≥ 200 ng/mL, and 8% had both. Their median survival in the presence of ascites was shorter if AFP was ≥ 200 ng/mL (19 mo vs 24 mo), and in the absence of ascites, patients with AFP ≥ 200 ng/mL had a shorter survival (28 mo vs 39 mo). For stage B patients, survival for the corresponding groups was 12, 18, 19 and 22 mo. The one-, two-, and three-year survival rates for stage A patients without ascites and AFP < 200 ng/mL were 94%, 77%, and 71%, respectively, and for patients with ascites and AFP ≥ 200 ng/mL were 83%, 24%, and 22%, respectively (P < 0.001). Adding ascites and AFP ≥ 200 ng/mL improved the discriminatory ability for predicting prognosis (area under the curve, 0.618 vs 0.579 for BCLC, P < 0.001).
CONCLUSION: Adding AFP and ascites to the BCLC staging classification can improve prognosis prediction for early and intermediate stages of hepatocellular carcinoma.
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Yau T, Tang VYF, Yao TJ, Fan ST, Lo CM, Poon RTP. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 2014; 146:1691-700.e3. [PMID: 24583061 DOI: 10.1053/j.gastro.2014.02.032] [Citation(s) in RCA: 534] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS We aimed to develop a prognostic classification scheme with treatment guidance for Asian patients with hepatocellular carcinoma (HCC). METHODS We collected data from 3856 patients with HCC predominantly related to hepatitis B treated at Queen Mary Hospital in Hong Kong from January 1995 through December 2008. Data on patient performance status, Child-Pugh grade, tumor status (size, number of nodules, and presence of intrahepatic vascular invasion), and presence of extrahepatic vascular invasion or metastasis were included, and randomly separated into training and test sets for analysis. Cox regression and classification and regression tree analyses were used to account for the relative effects of factors in predicting overall survival times and to classify disparate treatment decision rules, respectively; the staging system and treatment recommendation then were constructed by integration of clinical judgments. The Hong Kong Liver Cancer (HKLC) classification was compared with the Barcelona Clinic Liver Cancer (BCLC) classification in terms of discriminatory ability and effectiveness of treatment recommendation. RESULTS The HKLC system had significantly better ability than the BCLC system to distinguish between patients with specific overall survival times (area under the receiver operating characteristic curve values, approximately 0.84 vs 0.80; concordance index, 0.74 vs 0.70). More importantly, HKLC identified subsets of BCLC intermediate- and advanced-stage patients for more aggressive treatments than what were recommended by the BCLC system, which improved survival outcomes. Of BCLC-B patients classified as HKLC-II in our system, the survival benefit of radical therapies, compared with transarterial chemoembolization, was substantial (5-year survival probability, 52.1% vs 18.7%; P < .0001). In BCLC-C patients classified as HKLC-II, the survival benefit of radical therapies compared with systemic therapy was even more pronounced (5-year survival probability, 48.6% vs 0.0%; P < .0001). CONCLUSIONS We collected data from patients with HCC in Hong Kong to create a system to identify patients who are suitable for more aggressive treatment than the currently used BCLC system. The HKLC system should be validated in non-Asian patient populations and in patients with different etiologies of HCC.
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Affiliation(s)
- Thomas Yau
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Vikki Y F Tang
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong; Clinical Trials Centre, The University of Hong Kong, Hong Kong
| | - Tzy-Jyun Yao
- Clinical Trials Centre, The University of Hong Kong, Hong Kong
| | - Sheung-Tat Fan
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Chung-Mau Lo
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Ronnie T P Poon
- Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies, with an increasing incidence. With advances in surgical techniques and instrumentation and the development of molecular-target drugs, a number of potentially curative treatments have become available. Management of HCC patients depends on the stage of their tumor. Liver resection remains the first choice for very early-stage HCC, but it is being challenged by local ablative therapy. For early-stage HCC that meet the Milan criteria, liver transplantation still offers a better outcome; however, local ablative therapy can be a substitute when transplantation is not feasible. Local ablation is also used as a bridging therapy toward liver transplantation. HCC recurrence is the main obstacle to successful treatment, and there is currently no effective means of preventing or treating HCC recurrence. Transarterial therapy is considered suitable for intermediate-stage HCC, while sorafenib is recommended for advanced-stage HCC. This stage-based approach to therapy not only provides acceptable outcomes but also improves the quality of life of HCC patients. Because of the complexity of HCC, therapeutic approaches must be adapted according to the characteristics of each individual patient. This review discusses the current standards and trends in the treatment of HCC.
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Affiliation(s)
| | | | - Peter Schemmer
- *Deptment of General and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, Heidelberg 69120 (Germany), Tel. +49 0 6221 56 6110, E-Mail
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Prognosis predictability of hepatocellular carcinoma according to staging systems in hepatitis B virus-endemic area. Clin Res Hepatol Gastroenterol 2012; 36:357-64. [PMID: 22326248 DOI: 10.1016/j.clinre.2011.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/15/2011] [Accepted: 12/26/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no worldwide consensus on clinical application of staging systems that have been proposed for hepatocellular carcinoma (HCC). This study evaluated the predictors of survival and compared the prognosis predictability according to staging systems of HCC. PATIENTS AND METHODS We analyzed the medical records of 142 patients who were consecutively diagnosed as HCC in hepatitis B virus (HBV)-endemic area. To analyze the survival predictors and probability of staging systems, Kaplan-Meier method and Cox proportional hazard model were used. And to compare the discriminatory ability and predictive power of staging systems for prognosis and survival, likelyhood ratio χ(2) test and Akaike information criterion were applied. RESULTS Overall median survival of HCC patients was 24 months and 1-, 2-, and 3-year survival rate was 61.3, 49.4, and 45.7%, respectively. Child-Pugh classification (P=0.038) and portal vein thrombosis (PVT) (P=0.022) were ascertained as independent predictors of survival. Although all the staging systems showed a progressive decrease in survival as the tumor stage progressively advanced, the Japan Integrated Staging (JIS) and Chinese University Prognostic Index (CUPI) showed the highest homogeneity (small differences in survival among patients in the same stages), and the best monotonicity of gradient (the survival of patients in earlier stages is longer than the survival of patients in more advanced stages within the same system), respectively. CONCLUSION In HBV-endemic area, Child-Pugh classification and PVT were independent predictors for survival, and JIS and CUPI were the most powerful staging systems to predict the prognosis of HCC.
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Sirivatanauksorn Y, Tovikkai C. Comparison of staging systems of hepatocellular carcinoma. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2011; 2011:818217. [PMID: 21760664 PMCID: PMC3132503 DOI: 10.1155/2011/818217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 03/14/2011] [Accepted: 05/01/2011] [Indexed: 02/08/2023]
Abstract
Many staging systems of hepatocellular carcinoma (HCC) were established; however, there is no consensus on which is proper in predicting prognosis. This study aims to evaluate various commonly used staging systems of HCC. Patients who underwent surgery during 2001-2007 were included. All patient data were retrospectively staged using six staging systems, that are American Joint Committee on Cancer (AJCC) Tumour-Node-Metastasis (TNM), Okuda staging, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), Chinese University Prognostic Index (CUPI), and Japan Integrated Staging (JIS). Child-Pugh classification was also evaluated. The staging systems were compared by mean of overall and disease-free survival. Total of 99 patient data were enrolled in the analyses. All staging systems except Okuda were significant in determining overall survival in univariate analyses. In multivariate analyses, TNM and Child-Pugh demonstrated better predictive power for overall survival. In terms of disease-free survival, univariate analyses revealed that TNM, CLIP, BCLC, CUPI, and JIS were significant, and TNM was the best predictive staging system in multivariate analyses. In our study, TNM and Child-Pugh are the representative systems in predicting survival of HCC patients who undergo surgical resection. Moreover, they are practical and easily assessable in clinical practice.
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Affiliation(s)
- Yongyut Sirivatanauksorn
- HPB and Transplantation Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chutwichai Tovikkai
- HPB and Transplantation Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Yang T, Zhang J, Lu JH, Yang LQ, Yang GS, Wu MC, Yu WF. A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort. J Cancer Res Clin Oncol 2011; 137:739-750. [PMID: 20607551 DOI: 10.1007/s00432-010-0935-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/21/2010] [Indexed: 12/23/2022]
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 identify 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 χ(2) test 543.51, P < 0.001), monotonicity of gradients (linear trend χ(2) 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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Affiliation(s)
- Tian Yang
- Department of 2nd Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai, China
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Hsieh CB, Chung KP, Chu CM, Yu JC, Hsieh HF, Chu HC, Yu CY, Chen TW. Appropriate liver resection type for patients with the American joint committee on cancer classification T1 and T2 hepatocellular carcinoma. Eur J Surg Oncol 2011; 37:497-504. [PMID: 21450438 DOI: 10.1016/j.ejso.2011.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 12/12/2022] Open
Abstract
SYNOPSIS Major liver resection prevents intrahepatic tumor recurrence in T2 hepatocellular carcinoma patients with microvascular invasion or daughter nodules. BACKGROUND AND OBJECTIVES There is no consensus on whether major or minor hepatectomy is better for hepatocellular carcinoma (HCC) patients. We investigated the outcomes of liver resection type in resectable HCC patients. METHODS Two hundred sixty-three HCC patients with Child-Pugh class A liver function who underwent curative hepatectomy were enrolled. Among them, 186 patients had pathologic stage T1 HCC and 77 had stage T2 HCC. Patients were also classed according to the type of resection (major or minor). Clinicopathologic characteristics and outcomes were compared. RESULTS Patients with T1 HCC who underwent major resection had a higher rate of blood transfusion than those who underwent minor resection (P < 0.001). The disease-free survival rate of T2 patients who underwent major resection was better than that of patients who underwent minor resection (P = 0.004). The overall survival rates of T1 and T2 HCC patients did not differ significantly between those with major or minor resection. CONCLUSIONS Major liver resection is recommended for T2 HCC patients with adequate remnant liver function because it results in a better disease-free survival rate than does minor resection in these patients. Minor liver resection is suggested for T1 HCC patients, except for those with a tumor sitting close to vessels, because it is associated with a low incidence of blood transfusion and a good survival rate.
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Affiliation(s)
- C B Hsieh
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325 Sec. 2 Cheng-Kung Road, Taipei 114, Taiwan, ROC
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Xu LB, Wang J, Liu C, Pang HW, Chen YJ, Ou QJ, Chen JS. Staging systems for predicting survival of patients with hepatocellular carcinoma after surgery. World J Gastroenterol 2010; 16:5257-62. [PMID: 21049561 PMCID: PMC2975098 DOI: 10.3748/wjg.v16.i41.5257] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the staging systems for stratifying and predicting the prognosis of patients with hepatocellular carcinoma (HCC) after partial hepatectomy (PH).
METHODS: Clinical data about 438 HCC patients who underwent PH from January 1991 to December 2004 at our hospital were retrospectively analyzed. Tumor stage was evaluated following the Chinese tumor node metastasis (TNM) and barcelona clinic liver cancer (BCLC) staging systems, respectively. Survival curves for the HCC patients were plotted using the Kaplan-Meier method and differences were compared by the log-rank test. The accuracy of each system for predicting death of HCC patients was evaluated by calculating the area under the receiver operating characteristic curve.
RESULTS: The HCC patients were classified into stages I-III, stages I-IV and stages A-C, according to the 3 staging systems, respectively. Log-rank test showed that the cumulative survival rate was significantly different for the HCC patients at 3 Chinese system stages, TNM stages I and II, TNM stages III and IV, and 3 BCLC stages (P < 0.05). However, no significant difference was found in the HCC patients at TNM stages II and III. The accuracy of the Chinese and BCLC staging systems was higher than that of the TNM staging system for predicting the survival rate of HCC patients.
CONCLUSION: The Chinese and BCLC staging systems are better for stratifying and predicting the prognosis of HCC patients after PH than the TNM staging system.
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Vauthey JN, Dixon E, Abdalla EK, Helton WS, Pawlik TM, Taouli B, Brouquet A, Adams RB. Pretreatment assessment of hepatocellular carcinoma: expert consensus statement. HPB (Oxford) 2010; 12:289-99. [PMID: 20590901 PMCID: PMC2951814 DOI: 10.1111/j.1477-2574.2010.00181.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Staging of hepatocellular carcinoma (HCC) is complex and relies on multiple factors including tumor extent and hepatic function. No single staging system is applicable to all patients with HCC. The staging of the American Joint Committee on Cancer / International Union for Cancer Control should be used to predict outcome following resection or liver transplantation. The Barcelona Clinic Liver Cancer scheme is appropriate in patients with advanced HCC not candidate for surgery. Dual phase computed tomography or magnetic resonance imaging can be used for pretreatment assessment of tumor extent but the accuracy of these methods remains poor to characterize < 1 cm lesions. Assessment of tumor response should not rely only on tumor size and new imaging methods are available to evaluate response to therapy in HCC patients. Liver volumetry is part of the preoperative assessment of patients with HCC candidate for resection as it reflects liver function. Preoperative portal vein embolization is indicated in patients with small future liver remnant (≤ 20% in normal liver; ≤ 40% in fibrotic or cirrhotic liver). Tumor size is not a contraindication to liver resection. Liver resection can be proposed in selected patients with multifocal HCC. Besides tumor extent, surgical resection of HCC may be performed in selected patients with chronic liver disease.
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Affiliation(s)
- Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer CenterHouston, TX, USA
| | - Elijah Dixon
- Department of Surgery, University of CalgaryCalgary, Canada
| | - Eddie K Abdalla
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer CenterHouston, TX, USA
| | - W Scott Helton
- Department of Surgery, Hospital of Saint RaphaelNew Haven, CT
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD
| | - Bachir Taouli
- Department of Radiology, Mount Sinai School of MedicineNew York, NY
| | - Antoine Brouquet
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer CenterHouston, TX, USA
| | - Reid B Adams
- Department of Surgery, University of Virginia Health SystemCharlottesville, VA, USA
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Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 2010; 12:139-46. [PMID: 20495659 PMCID: PMC2826673 DOI: 10.1111/j.1477-2574.2009.00151.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/08/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver failure has remained a major cause of mortality after hepatectomy, but it is difficult to predict preoperatively. This study describes the introduction into clinical practice of the new LiMAx test and provides an algorithm for its use in the clinical management of hepatic tumours. METHODS Patients with hepatic tumours and indications for hepatectomy were investigated perioperatively with the LiMAx test. In one patient, analysis of liver volume was carried out with preoperative three-dimensional virtual resection. RESULTS A total of 329 patients with hepatic tumours were evaluated for hepatectomy. Blinded preoperative LiMAx values were significantly higher before resection (n= 139; mean 351 microg/kg/h, range 285-451 microg/kg/h) than before refusal (n= 29; mean 299 microg/kg/h, range 223-376 microg/kg/h; P= 0.009). In-hospital mortality rates were 38.1% (8/21 patients), 10.5% (2/19 patients) and 1.0% (1/99 patients) for postoperative LiMAx of <80 microg/kg/h, 80-100 microg/kg/h and >100 microg/kg/h, respectively (P < 0.0001). A decision tree was developed to avoid critical values and its prospective preoperative application revealed a reduction in mortality from 9.4% to 3.4% (P= 0.019). DISCUSSION The LiMAx test can validly determine liver function capacity and is feasible in every clinical situation. Combination with virtual resection could enable the calculation of residual liver function. The LiMAx decision tree algorithm for hepatectomy might significantly improve preoperative evaluation and postoperative outcome in liver surgery.
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Affiliation(s)
- Martin Stockmann
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | - Johan F Lock
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | - Maciej Malinowski
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | | | - Daniel Seehofer
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | - Peter Neuhaus
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
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Chen CL, Concejero AM. Liver transplantation for hepatocellular carcinoma in the world: the Taiwan experience. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:555-8. [PMID: 19760360 DOI: 10.1007/s00534-009-0166-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/13/2009] [Indexed: 01/12/2023]
Affiliation(s)
- Chao-Long Chen
- Liver Transplant Program, and Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Chang Gung University College of Medicine; 123 Ta-Pei Road Niao-Sung Kaohsiung Taiwan
| | - Allan M. Concejero
- Liver Transplant Program, and Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Chang Gung University College of Medicine; 123 Ta-Pei Road Niao-Sung Kaohsiung Taiwan
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Nathan H, Mentha G, Marques HP, Capussotti L, Majno P, Aldrighetti L, Pulitano C, Rubbia-Brandt L, Russolillo N, Philosophe B, Barroso E, Ferrero A, Schulick RD, Choti MA, Pawlik TM. Comparative performances of staging systems for early hepatocellular carcinoma. HPB (Oxford) 2009; 11:382-90. [PMID: 19768142 PMCID: PMC2742607 DOI: 10.1111/j.1477-2574.2009.00070.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 04/06/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several staging systems for patients with hepatocellular carcinoma (HCC) have been proposed, but studies of their prognostic accuracy have yielded conflicting conclusions. Stratifying patients with early HCC is of particular interest because these patients may derive the greatest benefit from intervention, yet no studies have evaluated the comparative performances of staging systems in patients with early HCC. METHODS A retrospective cohort study was performed using data on 379 patients who underwent liver resection or liver transplantation for HCC at six major hepatobiliary centres in the USA and Europe. The staging systems evaluated were: the Okuda staging system, the International Hepato-Pancreato-Biliary Association (IHPBA) staging system, the Cancer of the Liver Italian Programme (CLIP) score, the Barcelona Clinic Liver Cancer (BCLC) staging system, the Japanese Integrated Staging (JIS) score and the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system, 6th edition. A recently proposed early HCC prognostic score was also evaluated. The discriminative abilities of the staging systems were evaluated using Cox proportional hazards models and the bootstrap-corrected concordance index (c). RESULTS Overall survival of the cohort was 74% at 3 years and 52% at 5 years, with a median survival of 62 months. Most systems demonstrated poor discriminatory ability (P > 0.05 on Cox proportional hazards analysis, c approximately 0.5). However, the AJCC/UICC system clearly stratified patients (P < 0.001, c = 0.59), albeit only into two groups. The early HCC prognostic score also clearly stratified patients (P < 0.001, c = 0.60) and identified three distinct prognostic groups. DISCUSSION The early HCC prognostic score is superior to the AJCC/UICC staging system (6th edition) for predicting the survival of patients with early HCC after liver resection or liver transplantation. Other major HCC staging systems perform poorly in patients with early HCC.
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Affiliation(s)
- Hari Nathan
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Gilles Mentha
- Department of Transplantation and Visceral Surgery, University Hospitals of GenevaGeneva, Switzerland
| | - Hugo P Marques
- Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral HospitalLisbon, Portugal
| | | | - Pietro Majno
- Department of Transplantation and Visceral Surgery, University Hospitals of GenevaGeneva, Switzerland
| | - Luca Aldrighetti
- Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Carlo Pulitano
- Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Laura Rubbia-Brandt
- Department of Clinical Pathology, University Hospitals of GenevaGeneva, Switzerland
| | - Nadia Russolillo
- Unit of Hepato-Biliary-Pancreatic Surgery, AO Ordine MaurizianoTurin
| | - Benjamin Philosophe
- Department of Surgery, University of Maryland Medical CenterBaltimore, MD, USA
| | - Eduardo Barroso
- Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral HospitalLisbon, Portugal
| | | | - Richard D Schulick
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Michael A Choti
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
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Vitale A, Saracino E, Boccagni P, Brolese A, D'Amico F, Gringeri E, Neri D, Srsen N, Valmasoni M, Zanus G, Carraro A, Violi P, Pauletto A, Bassi D, Polacco M, Burra P, Farinati F, Feltracco P, Romano A, D'Amico D, Cillo U. Validation of the BCLC Prognostic System in Surgical Hepatocellular Cancer Patients. Transplant Proc 2009; 41:1260-3. [DOI: 10.1016/j.transproceed.2009.03.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Noda T, Sasaki Y, Yamada T, Eguchi H, Yano M, Ohigashi H, Ishikawa O, Imaoka S. Usefulness of the CLIP scoring system for prediction of postoperative prognosis of patients with large hepatocellular carcinoma. ACTA ACUST UNITED AC 2009; 16:538-45. [PMID: 19367360 DOI: 10.1007/s00534-009-0096-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/14/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND Some patients with large hepatocellular carcinoma (HCC > 10 cm in diameter) have favorable surgical outcome, but the selection criteria are controversial. The relationship among various staging systems [(AJCC/UICC TNM classification, Liver Cancer Study Group of Japan TNM classification, the Cancer of the Liver Italian Program (CLIP) scoring system and the Japan Integrated Staging scoring system] and postsurgical prognosis of patients with large HCC is unknown. The aim of this study was to identify the staging system with the best prognostic value for such patients. METHODS The subjects of this retrospective study were 42 patients with large HCC. Various prognostic factors were assessed by multivariate analysis. The disease state was staged by the above four staging systems. The accuracy of prediction of 1-year, 3-year and 5-year mortality for each system was evaluated by the area under the receiver operating characteristic curve. RESULTS Serum alpha-fetoprotein and curability were identified by multivariate analysis as the only significant prognostic factors. The discriminatory ability of the CLIP scoring system was superior to other systems. Patients with CLIP scores <2 had better prognosis (score = 0, 100% of 1-year survival rate; score = 1, 75%) than those with scores >2 (score = 2, 3 and 4; 50%, 46% and 33%, respectively). CONCLUSIONS The CLIP scoring system is the best for classifying patients with large HCC and prediction of their prognosis after surgery.
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Affiliation(s)
- Takehiro Noda
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Chen CH, Hu FC, Huang GT, Lee PH, Tsang YM, Cheng AL, Chen DS, Wang JD, Sheu JC. Applicability of staging systems for patients with hepatocellular carcinoma is dependent on treatment method--analysis of 2010 Taiwanese patients. Eur J Cancer 2009; 45:1630-9. [PMID: 19157858 DOI: 10.1016/j.ejca.2008.12.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/18/2008] [Indexed: 11/15/2022]
Abstract
The aim of this study was to compare six prognostic staging systems (Okuda stage, TNM stage, CLIP score, BCLC stage, JIS score and Tokyo score) in predicting survival in patients with hepatocellular carcinoma (HCC). A total of 2010 Taiwanese HCC patients were included. Demographic, laboratory and tumour characteristics were determined at diagnosis. Predictors of survival included serum levels of albumin, total bilirubin, alkaline phosphatase, alpha-fetoprotein, ascites, tumour size and portal vein invasion. The Tokyo score was the most informative one for predicting the survival of HCC patients as a whole, receiving surgical resection, or receiving transarterial chemoembolisation. CLIP score was the best fit system for HCC patients receiving chemotherapy or supportive care. Each staging system showed a significant difference in predicting the probability of survival across different stages. The applicability of staging systems for patients with HCC was dependent on treatment methods.
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Affiliation(s)
- Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei 10016, Taiwan
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Zhou L, Rui JA, Ye DX, Wang SB, Chen SG, Qu Q. Edmondson-Steiner grading increases the predictive efficiency of TNM staging for long-term survival of patients with hepatocellular carcinoma after curative resection. World J Surg 2009; 32:1748-56. [PMID: 18493820 DOI: 10.1007/s00268-008-9615-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The 6th edition TNM staging (TNM-6) for hepatocellular carcinoma (HCC) has been recommended. However, its superiority, in contrast to the previous 5th edition (TNM-5), has not been fully recognized. Besides, tumor differentiation was not included. The current study was designed to compare the value of these two staging systems and, more importantly, to elucidate whether Edmondson-Steiner grading, a well-acknowledged histological classification, is helpful in further discriminating different prognosis of HCC. METHODS Prospectively collected clinicopathological and follow-up data of consecutive 171 patients with HCC undergoing curative hepatic resection (CHR) were reviewed retrospectively. The impacts of variables on survival were determined by univariate and multivariate statistical analyses. RESULTS The differences of survival between stages of the TNM-6 and TNM-5 were almost significant, except for disease-free survival for TNM-5. Moreover, TNM-6 might be a more powerful prognostic predictor compared with TNM-5, although their impacts on survival were all not independent, unlike Edmondson-Steiner grading. For patients with each stage of TNM-6, Edmondson-Steiner grade was the sole significant variable in both univariate and multivariate analyses. Finally, a novel scoring criteria (prognostic scoring for CHR, PSCHR) integrating Edmondson-Steiner grading and TNM-6 was attempted and statistically shown to be of independent significance and stronger predicting value for prognosis of curatively resected HCC. CONCLUSION TNM-6 revealed to be more significantly prognostic than TNM-5 in patients with HCC after curative hepatic resection. Edmondson-Steiner grading could raise the predictive efficiency of TNM-6 for postresectional survival of patients with HCC. Therefore, PSCHR containing Edmondson-Steiner grading was preliminarily proposed.
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Affiliation(s)
- Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100032, China.
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Luo KZ, Itamoto T, Amano H, Oshita A, Ushitora Y, Tanimoto Y, Ohdan H, Tashiro H, Asahara T. Comparative study of the Japan Integrated Stage (JIS) and modified JIS score as a predictor of survival after hepatectomy for hepatocellular carcinoma. J Gastroenterol 2008; 43:369-77. [PMID: 18592155 DOI: 10.1007/s00535-008-2164-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 01/23/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of the study was to compare the abilities of the JIS and modified JIS (m-JIS) scores to predict survival after hepatectomy for hepatocellular carcinoma (HCC). METHODS Data for patients who underwent hepatectomy for HCC at Hiroshima University Hospital between 1986 and 2006 were included. The overall survival and disease-free survival were calculated by the Kaplan-Meier method, and differences between groups were tested by the log-rank test. The statistics of the Akaike information criterion (AIC) were used to show the more appropriate model. RESULTS A total of 626 patients were included (male/female, 468/158; mean age, 63.4+/-9.6 years; Child-Pugh class A/B, 524/102; liver damage grade A/B/C, 356/261/9). Mean survival and disease-free survival were 8.04+/-0.39 and 4.69+/-0.32 years, respectively. There was a significant difference in the overall survival rate between JIS scores 1 and 2, and 2 and 3 (P<0.05), but not between scores 0 and 1, or 3 and 4 (P>0.05). Except between m-JIS scores 0 and 1, there was excellent discriminatory ability in overall survival rate between other consecutive groups. Concerning disease-free survival, a significant difference was found only between JIS scores 1 and 2. However, the disease-free survival rate could be well differentiated between m-JIS scores 1 and 2, and 3 and 4. The m-JIS score had a higher discriminatory ability, indicated by a linear trend analysis, and a higher homogeneity likelihood ratio, and lower AIC statistics, than the original JIS score in predicting both overall and disease-free survival. CONCLUSIONS The modified-JIS scoring system using liver damage grade is better than the original JIS scoring system in predicting survival after hepatectomy for HCC in Japan.
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Affiliation(s)
- Kai-Zhong Luo
- Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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