Cancer Res Treat.  2014 Oct;46(4):348-357. 10.4143/crt.2013.142.

Multicenter Validation Study of a Prognostic Index for Portal Vein Tumor Thrombosis in Hepatocellular Carcinoma

• Yu JI
• Yoon SM
• Park HC
• Kim JH
• Kim TH
• Park JW
• Seong J
• Lee IJ
• Jang HS
• Kay CS
• Kim CY
• Chie EK
• Kim JH
• Kim MS
• Choi YM

• KMID: 2380372
• DOI: http://doi.org/10.4143/crt.2013.142

Abstract

PURPOSE
We previously reported on a staging system and prognostic index (PITH) for portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT) at a single institution. The aim of this study is to validate the PITH staging system using data from patients at other institutions and to compare it with other published staging systems.
MATERIALS AND METHODS
A total of 994 HCC patients with PVTT who were treated with RT between 1998 and 2011 by the Korean Radiation Oncology Group were analyzed retrospectively. All patients were staged using the Cancer of the Liver Italian Program (CLIP), Japanese Integrated Staging (JIS), Okuda, and PITH staging systems, and survival data were analyzed. The likelihood ratio, Akaike information criteria (AIC), time-dependent receiver operating characteristics, and prediction error curve analysis were used to determine discriminatory ability for comparison of staging systems.
RESULTS
The median survival was 9.2 months. Compared with the other staging systems, the PITH score gave the highest values for likelihood ratio and lowest AIC values, demonstrating that PITH may be a better prognostic model. Although the values were not significant and differences were not exceptional, the PITH score showed slightly better performance with respect to time-dependent area under curve and integrated Brier score of prediction error curve.
CONCLUSION
The PITH staging system was validated in this multicenter retrospective study and showed better stratification ability in HCC patients with PVTT than other systems.

Keyword

Hepatocellular carcinoma; Portal vein; Radiotherapy; Multicenter study; Validation

MeSH Terms

Area Under Curve
Asian Continental Ancestry Group
Carcinoma, Hepatocellular*
Humans
Liver Neoplasms
Portal Vein*
Radiation Oncology
Radiotherapy
Retrospective Studies
ROC Curve
Thrombosis*

Figure

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  Fig. 1. Overall survival according to radiotheraphy response. Median survival for complete response, partial response, stable disease, and progressive disease was 32 months, 13.1 months, 7.1 months, and 4.2 months, respectively.

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  Fig. 2. Overall survival according to the score from each staging system. (A) Prognostic index of the portal vein tumor thrombosis in hepatocellular carcinoma (PITH). (B) Okuda. (C) Cancer of the Liver Italian Program (CLIP). (D) Japanese Integrated System (JIS).

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  Fig. 3. Overall survival according to the stage from each staging system. (A) Prognostic index of the portal vein tumor thrombosis in hepatocellular carcinoma (PITH). (B) Okuda. (C) Cancer of the Liver Italian Program (CLIP).

Reference

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