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Evaluation of histological staging systems for primary biliary cirrhosis: correlation with clinical and biochemical factors and significance of pathological parameters in prognostication
Author(s) -
Chan Anthony W H,
Chan Ronald C K,
Wong Grace L H,
Wong Vincent W S,
Choi Paul C L,
Chan Henry L Y,
To KaFai
Publication year - 2014
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12384
Subject(s) - medicine , proportional hazards model , gastroenterology , cirrhosis , pathological , bilirubin , primary biliary cirrhosis , rank correlation , retrospective cohort study , stage (stratigraphy) , cohort , staging system , survival analysis , log rank test , hazard ratio , confidence interval , biology , statistics , cancer , paleontology , mathematics
Aims A new J apanese histological staging system for primary biliary cirrhosis ( PBC ) has been proposed. We aimed to evaluate the efficacies of the S cheuer, L udwig and J apanese staging systems, with emphasis on their clinical and biochemical correlations and prognostic significances. Methods and results We conducted a retrospective review of a cohort of 58 C hinese PBC patients, with follow‐up of up to 16.9 years. All three systems correlated well with prognostically significant parameters, namely serum bilirubin, Mayo scores and model for end‐stage liver disease ( MELD ) score. Only the J apanese staging system was associated with Child–Pugh score, which was the single independent prognostic factor for liver‐related events (log‐rank P < 0.001; Cox proportional hazard ratio ( HR ) 6.723, P < 0.001). The J apanese system (log‐rank P = 0.007; Cox proportional HR 10.400, P = 0.025) predicted liver‐related events, while S cheuer (log‐rank P = 0.112) and Ludwig (log‐rank P = 0.147) systems did not. The copper‐associated protein ( CAP ) deposition score, a component of the Japanese system, was the most powerful histological prognostic parameter (log‐rank P < 0.001; Cox proportional HR 99.534, P = 0.049) and provided extra prognostic values in additional to serum albumin, serum bilirubin, Child–Pugh score, M ayo scores and MELD score. Conclusion The J apanese staging system is more effective than classical systems. The degree of CAP deposition is an essential prognostic histological parameter.