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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Comparative prognostic performance of staging systems for hepatocellular carcinoma: Evidence from a Vietnamese cohort
Tuong-Anh Mai-Phan1,2, Trong-Kha Nguyen1, Tri-Nhan Pham1,3
1Department of Hepato-Pancreato-Biliary, Nhan dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam.
Insights
The Hong Kong Liver Cancer (HKLC) and Barcelona Clinic Liver Cancer (BCLC) staging systems best predict survival for hepatocellular carcinoma (HCC) patients in Vietnam. These models are recommended for clinical use to improve patient outcomes.
Area of Science:
- Hepatocellular Carcinoma (HCC) Research
- Cancer Prognostics and Staging Systems
- Clinical Epidemiology in Vietnam
Background:
- Hepatocellular carcinoma (HCC) is a major global health concern, particularly in Vietnam due to high rates of hepatitis B and C virus infections.
- Accurate prognostication is essential for effective HCC management and treatment planning.
- Existing staging systems (BCLC, HKLC, CLIP, ITA.LI.CA, JIS, Tokyo Score, MESIAH) lack comparative validation in the Vietnamese population.
Purpose of the Study:
- To evaluate and compare the prognostic accuracy of seven established HCC staging systems.
- To identify the optimal staging model for predicting survival in Vietnamese HCC patients.
Main Methods:
- Retrospective cohort study of 987 HCC patients diagnosed in Vietnam (2016-2023).
- Patients were assessed using Barcelona Clinic Liver Cancer (BCLC), Hong Kong Liver Cancer (HKLC), Cancer of the Liver Italian Program (CLIP), Italian Liver Cancer (ITA.LI.CA), Japan Integrated Staging (JIS), Tokyo Score, and MESIAH staging systems.
- Prognostic performance was measured using ROC curve analysis, Harrell's concordance index, and calibration plots.
Main Results:
- The HKLC and BCLC systems demonstrated the highest discriminatory power for predicting survival at 12 and 36 months.
- CLIP and ITA.LI.CA showed superior calibration, especially at 36 months.
- The JIS system performed poorly in discrimination; HKLC showed consistent performance across different viral etiologies and treatments.
Conclusions:
- The HKLC and BCLC staging systems offer superior prognostic performance for HCC patients in Vietnam.
- The findings support the adoption of the HKLC system in clinical practice for improved patient management and outcomes in Vietnam.
Background:
Hepatocellular carcinoma (HCC), the sixth most common cancer and fourth-leading cause of cancer-related mortality globally, imposes a significant burden in Vietnam due to endemic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Accurate prognostication is crucial for optimizing treatment and outcomes. Numerous staging systems exist, including the Barcelona Clinic Liver Cancer (BCLC), Hong Kong Liver Cancer (HKLC), cancer of the liver Italian Program (CLIP), Italian Liver Cancer (ITA.LI.CA), Japan Integrated Staging (JIS), Tokyo Score, and model to estimate survival in ambulatory HCC patients (MESIAH). However, their comparative performance in Vietnamese patients remains underexplored.
Aim:
To compare the prognostic accuracy of seven HCC staging systems in predicting survival and identify the optimal model.
Methods:
This retrospective cohort study included 987 patients with HCC diagnosed at Nhan dan Gia Dinh Hospital, Vietnam, from January 2016 to December 2023. Patients were staged using BCLC, HKLC, CLIP, ITA.LI.CA, JIS, Tokyo score, and MESIAH. Overall survival was analyzed using Kaplan-Meier methods, and prognostic performance was evaluated via the area under the receiver operating characteristic (ROC) curve, Harrell's concordance index, and calibration plots.
Results:
The HKLC and BCLC systems demonstrated the highest discriminatory ability, with area under the ROC curves of 0.834 and 0.830, respectively, at 12 months and 0.859 for both systems at 36 months. CLIP and ITA.LI.CA exhibited superior calibration, particularly at 36 months. The JIS system consistently showed the poorest discriminatory performance. Subgroup analyses revealed that HKLC maintained strong performance across different viral etiologies (HBV, HCV, non-B-non-C) and treatment modalities (transarterial chemoembolization, surgery, ablation).
Conclusion:
The HKLC and BCLC systems showed superior prognostic performance for Vietnamese patients with HCC, supporting HKLC adoption in clinical practice.
