Prognostic evaluation of HCC patients undergoing surgical resection: an analysis of 8 different staging systems
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ORIGINAL ARTICLE
Prognostic evaluation of HCC patients undergoing surgical resection: an analysis of 8 different staging systems Jan Bednarsch 1 & Zoltan Czigany 1 & Daniel Heise 1 & Katharina Joechle 1 & Tom Luedde 2 & Lara Heij 1,3 & Philipp Bruners 4 & Tom Florian Ulmer 1 & Ulf Peter Neumann 1,5 & Sven Arke Lang 1 Received: 2 September 2020 / Accepted: 2 December 2020 # The Author(s) 2020
Abstract Purpose No consensus exists regarding the most appropriate staging system to predict overall survival (OS) for hepatocellular carcinoma (HCC) in surgical candidates. Thus, we aimed to determine the prognostic ability of eight different staging systems in a European cohort of patients undergoing liver resection for HCC. Methods Patients resected for HCC between 2010 and 2019 at our institution were analyzed with Kaplan-Meier and Cox regression analyses. Likelihood ratio (LR) χ2 (homogeneity), linear trend (LT) χ2 (discriminatory ability), and Akaike Information Criterion (AIC, explanatory ability) were used to determine the staging system with the best overall prognostic performance. Results Liver resection for HCC was performed in 160 patients. Median OS was 39 months (95% confidence interval (CI): 32– 46 months) and median RFS was 26 months (95% CI: 16–34 months). All staging systems (BCLC, HKLC, Okuda, CLIP, ITA.LI.CA staging and score, MESH, and GRETCH) showed significant discriminatory ability regarding OS, with ITA.LI.CA score (LR χ2 30.08, LT χ2 13.90, AIC 455.27) and CLIP (LR χ2 28.65, LT χ2 18.95, AIC 460.07) being the best performing staging systems. Conclusions ITA.LI.CA and CLIP are the most suitable staging system to predict OS in European HCC patients scheduled for curative-intent surgery. Keywords HCC . Staging system . ITA.LI.CA . CLIP . Liver resection
Abbreviations AIC Akaike Information Criterion ALD Alcoholic liver disease ALT Alanine aminotransferase AP Alkaline phosphatase
* Sven Arke Lang [email protected] 1
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
2
Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
3
Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
4
Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany
5
Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
ASA AST BCLC BMI CLIP CPS CI CRP CT CUPI CUSA CVP DFS ECOG ESMO FFP FLR GCP GGT
American Society of Anesthesiologists Aspartate aminotransferase Barcelona Clinic Liver Cancer Body mass index Cancer of Liver Italian Program Child-Pugh score Confidence interval C-reactive protein Computed tomography Chinese University Integrated System Cavitron Ultrasonic Surgical Aspirator Central venous pressure Disease-free survival Eastern Cooperative Oncology Group European Society for Medical Oncology Fresh frozen plasma Future liver remnant Good clinical practice Gamma glutamyltransferase
Langenbecks Arch Surg
GRETCH HCC HKLC INR ISGLS ITA.LI.CA JIS LR L
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