A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire.
OBJECTIVE
In patients with hepatocellular carcinoma, prediction of survival is difficult. The aim of this prospective study was to provide a simple classification for predicting survival of patients with hepatocellular carcinoma, based on a multivariable Cox model.


METHODS
Seven hundred and sixty-one patients who presented with hepatocellular carcinoma from 24 Western medical centers were enrolled over a 30-month period. Patients were randomly assigned to either a training sample (n=506, with 418 deaths) from which a classification system was established, or a test sample (n=255, with 200 deaths) for validating its prognostic significance.


RESULTS
Five prognostic factors were selected at the 0.0001 level: Karnofsky index <80% (relative risk of death=2.2, 95% confidence interval: 1.7-2.7), serum bilirubin >50 micromol/l (relative risk=2.1, 95% confidence interval: 1.7-2.6), serum alkaline phosphatase at least twice the upper limit of normal range (relative risk=1.6, 95% confidence interval: 1.3-2.0), serum alpha-fetoprotein >35 microg/l (relative risk=1.7, 95% confidence interval: 1.4-2.1), and ultrasonographic portal obstruction (relative risk=1.3, 95% confidence interval: 1.1-1.7). Three risk groups with different 1-year survival rates (72%, 34%, 7%) were derived, and independently validated in the test sample (79%, 31%, 4%).


CONCLUSIONS
This classification could be useful in the assessment of prognosis from homogeneous groups of patients with respect to their expected outcome.
Chevret
S
S
Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, Paris, France. chevret@dbim.jussieu.fr
Trinchet
J C
JC
Mathieu
D
D
Rached
A A
AA
Beaugrand
M
M
Chastang
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002170:Canada; D006528:Carcinoma, Hepatocellular / Q000145:classification* / Q000401:mortality*; D016001:Confidence Intervals; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors