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V‐CLIP: Integrating plasma vascular endothelial growth factor into a new scoring system to stratify patients with advanced hepatocellular carcinoma for clinical trials
Author(s) -
Kaseb Ahmed O.,
Hassan Manal M.,
Lin E,
Xiao Lianchun,
Kumar Vikas,
Pathak Priyanka,
Lozano Richard,
Rashid Asif,
Abbruzzese James L.,
Morris Jeffrey S.
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.25791
Subject(s) - medicine , hepatocellular carcinoma , vascular endothelial growth factor , oncology , confidence interval , proportional hazards model , vegf receptors , prospective cohort study , overall survival , multivariate analysis , gastroenterology
Abstract BACKGROUND: Several staging systems have been proposed for hepatocellular carcinoma (HCC); however, none has incorporated circulating angiogenic biomarkers. The purpose of this study was to determine whether vascular endothelial growth factor (VEGF) could independently predict overall survival in patients with HCC, and whether adding VEGF level into the Cancer of the Liver Italian Program (CLIP) score could improve patient stratification and prediction of overall survival. METHODS: Between 2001 and 2008, baseline plasma VEGF levels were available from 288 patients, and multivariate Cox regression models and median survival (95% confidence intervals) were calculated. Recursive partitioning was used to determine the optimal cutpoint for VEGF, using 10 repeated training/validation samples, each using two‐thirds of the data to determine the best cutpoint and the remaining one‐third to validate it. Prognostic ability of CLIP and V‐CLIP was compared using the concordence index. RESULTS: Plasma VEGF was a significant independent predictor of overall survival, with an optimal VEGF cutpoint of 450 pg/mL. After CLIP validation in our patients, we added VEGF to the CLIP score and found that the new V‐CLIP score better separates patients into homogenous prognostic groups ( P = .005). CONCLUSIONS: The assessment of baseline plasma VEGF levels increases the precision of the CLIP scoring system for predicting HCC prognosis, which may assist in equally randomizing patients with HCC in clinical trials. Prospective validation of the V‐CLIP scoring system is warranted. Cancer 2011. © 2010 American Cancer Society.