Development of a prognostic scoring system for resectable hepatocellular carcinoma

Carlo Sposito, Stefano Di Sandro, Federica Brunero, Vincenzo Buscemi, Carlo Battiston, Andrea Lauterio, Marco Angelo Bongini, Luciano De Carlis, Vincenzo Mazzaferro

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

AIM To develop a prognostic scoring system for overall survival (OS) of patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC). METHODS Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) surgical criteria by means of Harrell's C statistics. RESULTS A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training (P < 0.0001) and the validation set (P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/ AASLD guidelines (77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell's C statistics revealed no significant difference in predictive power between the two systems (-0.00999, P = 0.667). CONCLUSION This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/ AASLD criteria with no harm on survival.

Original languageEnglish
Pages (from-to)8194-8202
Number of pages9
JournalWorld Journal of Gastroenterology
Volume22
Issue number36
DOIs
Publication statusPublished - Sep 28 2016

Fingerprint

Hepatocellular Carcinoma
Survival
Liver
Liver Diseases
Proportional Hazards Models
End Stage Liver Disease
Virus Diseases
Hepacivirus
Blood Vessels
Guidelines

Keywords

  • Hepatocellular carcinoma
  • Liver cirrhosis
  • Liver resection
  • Prognosis
  • Survival study

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Development of a prognostic scoring system for resectable hepatocellular carcinoma. / Sposito, Carlo; Di Sandro, Stefano; Brunero, Federica; Buscemi, Vincenzo; Battiston, Carlo; Lauterio, Andrea; Bongini, Marco Angelo; De Carlis, Luciano; Mazzaferro, Vincenzo.

In: World Journal of Gastroenterology, Vol. 22, No. 36, 28.09.2016, p. 8194-8202.

Research output: Contribution to journalArticle

Sposito, Carlo ; Di Sandro, Stefano ; Brunero, Federica ; Buscemi, Vincenzo ; Battiston, Carlo ; Lauterio, Andrea ; Bongini, Marco Angelo ; De Carlis, Luciano ; Mazzaferro, Vincenzo. / Development of a prognostic scoring system for resectable hepatocellular carcinoma. In: World Journal of Gastroenterology. 2016 ; Vol. 22, No. 36. pp. 8194-8202.
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T1 - Development of a prognostic scoring system for resectable hepatocellular carcinoma

AU - Sposito, Carlo

AU - Di Sandro, Stefano

AU - Brunero, Federica

AU - Buscemi, Vincenzo

AU - Battiston, Carlo

AU - Lauterio, Andrea

AU - Bongini, Marco Angelo

AU - De Carlis, Luciano

AU - Mazzaferro, Vincenzo

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N2 - AIM To develop a prognostic scoring system for overall survival (OS) of patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC). METHODS Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) surgical criteria by means of Harrell's C statistics. RESULTS A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training (P < 0.0001) and the validation set (P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/ AASLD guidelines (77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell's C statistics revealed no significant difference in predictive power between the two systems (-0.00999, P = 0.667). CONCLUSION This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/ AASLD criteria with no harm on survival.

AB - AIM To develop a prognostic scoring system for overall survival (OS) of patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC). METHODS Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) surgical criteria by means of Harrell's C statistics. RESULTS A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training (P < 0.0001) and the validation set (P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/ AASLD guidelines (77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell's C statistics revealed no significant difference in predictive power between the two systems (-0.00999, P = 0.667). CONCLUSION This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/ AASLD criteria with no harm on survival.

KW - Hepatocellular carcinoma

KW - Liver cirrhosis

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KW - Prognosis

KW - Survival study

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