Lee, Jeong-Hoon; Kim, Hwi Young; Kim, Yoon Jun; Yoon, Jung-Hwan; Chung, Jin Wook; Lee, Hyo-Suk
Journal of gastroenterology and hepatology
2015Apr ; 30 ( 4 ) :696-705.
PMID : 25250761
ÀúÀÚ »ó¼¼Á¤º¸
Lee, Jeong-Hoon -
Kim, Hwi Young -
Kim, Yoon Jun -
Yoon, Jung-Hwan -
Chung, Jin Wook -
Lee, Hyo-Suk -
ABSTRACT
BACKGROUND AND AIM: A uniform staging system for hepatocellular carcinoma (HCC) is needed. In this study, the discrimination abilities of HCC staging systems (American Joint Committee on Cancer [AJCC], Barcelona Clinic Liver Cancer [BCLC], Cancer of the Liver Italian Program, and Okuda stage) were compared during the course of untreated HCC.
METHODS: We included consecutive 80 patients diagnosed with HCC, but were not treated for HCC, at a single medical center in Korea. In addition, 177 treated patients matched by prognostic factors were included to evaluate the survival gain owing to locoregional treatment.
RESULTS: The mean age of untreated patients was 58.7 years. During the observation period (median?=?41.1 months), 72 patients died (median survival?=?2.1 months; range?=?1.6-33.7 months). Among various staging systems, the BCLC system had the best discrimination ability (linear trend ?2 ?=?16.35). Multivariate analysis indicated that the intrahepatic tumor classification (AJCC T classification) was an independent predictor of overall survival (OS) (P?=?0.001). However, either node or metastasis classification failed to affect the OS significantly (both P?>?0.05). Patients undergoing intrahepatic tumor control with locoregional therapy showed prolonged survival in those patients with nodal involvement (hazard ratio?=?0.315; P?=?0.004) and extrahepatic metastasis (hazard ratio?=?0.658; P?=?0.258), respectively, after adjustment for independent prognostic factors. Compared with untreated patients, BCLC stage A and B patients had >?1 year of survival gain but those with stage C and D did not, owing to locoregional therapy. CONCLUSION: The BCLC system had the best discrimination among untreated HCC patients. However, re-evaluation of the clinical importance of nodal and metastasis classification might be required. CI - ??2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
keyword
hepatocellular carcinoma; natural history; overall survival; staging system
MESH
Adolescent, Adult, Carcinoma, Hepatocellular/mortality/*pathology/therapy, Child, *Endemic Diseases, Female, Hepatitis B/*epidemiology, Humans, Korea/epidemiology, Liver Neoplasms/mortality/*pathology/therapy, Male, Middle Aged, Multivariate Analysis, Neoplasm Staging/*methods, Predictive Value of Tests, Prognosis, Survival Rate, Young Adult
¸µÅ©