A prognostic index for patients within the intermediate stage of hepatocellular carcinoma

Eur J Gastroenterol Hepatol. 2016 May;28(5):592-8. doi: 10.1097/MEG.0000000000000562.

Abstract

Objective: The Barcelona Clinic Liver Cancer algorithm is the most widely used staging system for hepatocellular carcinoma, but the intermediate stage of this classification comprises a very heterogeneous group of patients with different survival probabilities. The aim of our study was to construct a simple prognostic index for identifying subgroups of patients with different prognoses within the intermediate stage.

Patients and methods: Three-hundred and seven patients were retrospectively analyzed and randomly divided into a training sample (n=205), from which the model was developed, and a test sample (n=102), to independently assess the model's performance.

Results: Four variables were retained in the final multivariate model: hepatic failure, number of nodules, α-fetoprotein, and albumin, with hazard ratios equal to 2.22 (95% confidence interval: 1.52-3.24), 1.47 (1.00-2.18), 2.34 (1.56-3.52), and 1.75 (1.26-2.44), respectively. The score system was derived by summing up the linear weights assigned to the four covariates according to the observed regression coefficients. The score ranged between 4 and 13; to avoid sparse-data bias arising from small numbers within strata, only four categories (4-5, 6-7, 8-9, 10-13) were identified. The prognosis worsened significantly with increasing score and the C-index for discriminatory accuracy was equal to 0.66 (95% confidence interval: 0.60-0.72). The score was validated in the test sample (log-rank test P=0.02). Similar results were found when evaluating the score as a continuous variable.

Conclusion: The simple prognostic index predicts survival in patients with intermediate-stage hepatocellular carcinoma. This score might help guide treatment selection and patient stratification in clinical studies.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Algorithms
  • Biomarkers, Tumor / blood*
  • Carcinoma, Hepatocellular / blood
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / diagnosis*
  • Carcinoma, Hepatocellular / mortality
  • Decision Support Techniques*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Linear Models
  • Liver Failure / diagnosis
  • Liver Failure / etiology
  • Liver Neoplasms / blood
  • Liver Neoplasms / complications
  • Liver Neoplasms / diagnosis*
  • Liver Neoplasms / mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Neoplasms, Multiple Primary*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Serum Albumin / analysis*
  • Serum Albumin, Human
  • alpha-Fetoproteins / analysis*

Substances

  • AFP protein, human
  • ALB protein, human
  • Biomarkers, Tumor
  • Serum Albumin
  • alpha-Fetoproteins
  • Serum Albumin, Human