Cancer Res Treat.  2018 Apr;50(2):366-373. 10.4143/crt.2017.126.

Sub-classification of Advanced-Stage Hepatocellular Carcinoma: A Cohort Study Including 612 Patients Treated with Sorafenib

• Yoo JJ
• Chung GE
• Lee JH
• Nam JY
• Chang Y
• Lee JM
• Lee DH
• Kim HY
• Cho EJ
• Yu SJ
• Kim YJ
• Yoon JH
• Seoul Liver Group

• KMID: 2411126
• DOI: http://doi.org/10.4143/crt.2017.126

Abstract

PURPOSE
Advanced hepatocellular carcinoma (HCC) is associated with various clinical conditions including major vessel invasion, metastasis, and poor performance status. The aim of this study was to establish a prognostic scoring system and to propose a sub-classification of the Barcelona-Clinic Liver Cancer (BCLC) stage C.
MATERIALS AND METHODS
This retrospective study included consecutive patients who received sorafenib for BCLC stage C HCC at a single tertiary hospital in Korea. A Cox proportional hazard model was used to develop a scoring system, and internal validationwas performed by a 5-fold cross-validation. The performance of the model in predicting risk was assessed by the area under the curve and the Hosmer-Lemeshow test.
RESULTS
A total of 612 BCLC stage C HCC patients were sub- classified into strata depending on their performance status. Five independent prognostic factors (Child-Pugh score, α-fetoprotein, tumor type, extrahepatic metastasis, and portal vein invasion) were identified and used in the prognostic scoring system. This scoring system showed good discrimination (area under the receiver operating characteristic curve, 0.734 to 0.818) and calibration functions (both p < 0.05 by the Hosmer-Lemeshow test at 1 month and 12 months, respectively). The differences in survival among the different risk groups classified by the total score were significant (p < 0.001 by the log-rank test in both the Eastern Cooperative Oncology Group 0 and 1 strata).
CONCLUSION
The heterogeneity of patientswith BCLC stage C HCC requires sub-classification of advanced HCC. A prognostic scoring system with five independent factors is useful in predicting the survival of patients with BCLC stage C HCC.

Keyword

Hepatocellular carcinoma; Advanced-stage; Sorafenib; Prognosis

MeSH Terms

Calibration
Carcinoma, Hepatocellular*
Cohort Studies*
Discrimination (Psychology)
Humans
Korea
Liver Neoplasms
Neoplasm Metastasis
Population Characteristics
Portal Vein
Prognosis
Proportional Hazards Models
Retrospective Studies
ROC Curve
Tertiary Care Centers

Figure

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  Fig. 1. The results of internal validation using 5-fold cross-validation at each time point.

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  Fig. 2. Kaplan-Meier analysis of the cumulative overall survival rate according to the risk group. (A) Eastern Cooperative Oncology Group performance status (ECOG PS) 0. (B) EGOG PS 1.

Reference

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