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Comparison of staging systems to predict survival in hepatocellular carcinoma
Author(s) -
Pascual Sonia,
Zapater Pedro,
Such José,
GarcíaHerola Antonio,
Sempere Laura,
Irurzun Javier,
Palazón José María,
Carnicer Fernando,
PérezMateo Miguel
Publication year - 2006
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2006.01282.x
Subject(s) - hepatocellular carcinoma , medicine , proportional hazards model , liver cancer , survival analysis , stage (stratigraphy) , oncology , overall survival , staging system , log rank test , gastroenterology , cancer , biology , paleontology
Purpose: Some new staging systems in hepatocellular carcinoma (HCC) have been described in the last years. The aim of this study was to compare the survival‐predicting capacity of some variables and the prognostic classifications. Methods: Demographic, clinical, analytical variables and tumour characteristics were collected in a study including 115 patients with HCC. Predictors of survival were identified using the Kaplan–Meier test and the Cox model. Comparison between different staging systems was carried out. Results: The 1‐, 2‐ and 3‐year estimated survival was 65%, 45% and 30%, respectively. Child–Pugh score and α‐fetoprotein level greater than 400 UI/l were independent predictors of survival in the Cox model. Although all systems correctly differentiated between patients regarding survival (Kaplan–Meier, log rank <0.05 for all), the Barcelona Clinic Liver Cancer (BCLC) showed a better discriminatory ability than the other evaluated scores. In addition, the independent homogenizing ability and stratification value of BCLC was better than that of other systems. On the contrary, model for end‐stage liver disease (MELD) showed the worst results. Conclusions: Child–Pugh score and α‐fetoprotein levels were the only independent predictors of survival in patients with HCC. Child–Pugh score showed a better prediction value for survival when compared with MELD. BCLC is more accurate than the other prognostic models evaluated in this investigation.