Comparison of seven prognostic staging systems in patients who undergo hepatectomy for hepatocellular carcinoma.

Abstract

BACKGROUND/AIMS: Various staging systems containing both the tumor and liver function factors for hepatocellular carcinoma (HCC) have been proposed. The aim of this study was to evaluate the appropriate staging system in patients received hepatic resection for HCC. METHODOLOGY: The prognosis of the 235 patients who had undergone hepatectomy in these 15 years were analyzed according to the 7 staging systems, the Cancer of the Liver Italian Program (CLIP) score, the Barcelona Clinic Liver Cancer (BCLC) staging, the Groupe d'Etude et de Traitment du Carcinome Hépatocellulaire (GETCH) classification, the Chinese University Prognostic Index (CUPI) grade, the Japan Integrated Staging (JIS) score, modified JIS (mJIS) score, and Tokyo score. The capabilities to differentiate the postoperative survival between the neighboring score in each staging system were examined. Statistical analyses of the log-rank test, linear trend test, likelihood ratio (LR) test, Akaike Information Criteria (AIC), and Harrels' c-index were used. RESULTS: The patients were widely distributed in the most of the staging system with the exceptions of GETCH classification and CUPI grade where almost all patients were classified to only the two groups. CLIP, JIS, mJIS, and Tokyo scores significantly differentiated the postoperative survival rate between 2 or 3 neighboring scores, whereas other staging systems only did between one. Statistical evaluations of prognostic stratification by the LR test, AIC, and Harrels' c-index showed that the JIS score system was the best among the 7 staging systems. CONCLUSIONS: JIS score is the best staging system for HCC in patients who undergo hepatectomy.