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Intermediate-stage hepatocellular carcinoma treated with hepatic resection: the NSP score as an aid to
Yong-Fa Zhang1,2,3, Jie Zhou4, Wei Wei1,2,3
1The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Background:
The subgroups of patients with intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) who would truly benefit from hepatic resection (HR) are unknown. An objective point score was established to guide the selection of these patients for HR.
Methods:
In all, 255 consecutive patients with intermediate-stage HCC treated with HR were evaluated retrospectively and included in this study (the training cohort). The variables on overall survival (OS, log-rank test) were investigated and a point score (the NSP score) was developed by using a Cox-regression model and validated in an independent external cohort from another institution (n=169).
Results:
The NSP score differentiated two groups of patients (⩽1, >1 point) with distinct prognoses (median OS, 61.3 vs 19.3 months; P<0.001). A high NSP score was associated with increased major adverse events after HR (5.6 vs 13.8%, P=0.027). Its predictive accuracy as determined by the area under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years (AUCs 0.688, 0.739, and 0.732) was greater than the other six staging systems for HCC (0.513-0.677). The findings were supported by the validation cohort.
Conclusions:
The NSP scoring system is more accurate in selecting patients with intermediate-stage HCC for HR.
