Sub-classification of Advanced-Stage Hepatocellular Carcinoma: A Cohort Study Including 612 Patients Treated with Sorafenib.
- Author:
Jeong Ju YOO
1
;
Goh Eun CHUNG
;
Jeong Hoon LEE
;
Joon Yeul NAM
;
Young CHANG
;
Jeong Min LEE
;
Dong Ho LEE
;
Hwi Young KIM
;
Eun Ju CHO
;
Su Jong YU
;
Yoon Jun KIM
;
Jung Hwan YOON
Author Information
- Publication Type:Original Article
- Keywords: Hepatocellular carcinoma; Advanced-stage; Sorafenib; Prognosis
- MeSH: 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
- From:Cancer Research and Treatment 2018;50(2):366-373
- CountryRepublic of Korea
- Language:English
- 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.
