Selecting an Optimal Staging System for Intermediate-Stage Hepatocellular Carcinoma: Comparison of 9 Currently Used...

Area of Science:

• Hepatology
• Oncology
• Medical Statistics

Background:

• Accurate staging is crucial for intermediate-stage hepatocellular carcinoma (HCC).
• The optimal prognostic system for intermediate-stage HCC remains undetermined.
• This study evaluates nine current HCC staging systems.

Purpose of the Study:

• To compare the prognostic performance of nine HCC staging systems.
• To identify the best staging system for predicting survival in intermediate-stage HCC.
• To identify independent prognostic factors for HCC survival.

Main Methods:

• A cohort of 880 intermediate-stage HCC patients (2005-2014) was analyzed.
• Prognostic performance of nine staging systems was compared using Harrell's c-index and Akaike information criterion.
• Independent prognostic variables were identified through multivariate analysis.

Main Results:

• Alkaline phosphatase (ALP), AST, etiology, AFP, Child-Pugh stage, tumor size, and number were independent prognostic factors.
• The Hong Kong Liver Cancer (HKLC) staging system demonstrated the highest predictive accuracy (c-index) and best model fit (AIC).
• HKLC remained the superior model for patients undergoing hepatic resection or transarterial chemoembolization.

Conclusions:

• The HKLC staging system is a stable and superior prognostic model for intermediate-stage HCC.
• HKLC consistently outperforms other systems across different treatment strategies.
• Optimal staging system selection can enhance future clinical trial design for intermediate-stage HCC.