title: A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire.
abstract: 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.
authors.affiliation: Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, Paris, France. chevret@dbim.jussieu.fr
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.forename: J C
authors.initials: JC
authors.lastname: Trinchet
authors.forename: D
authors.initials: D
authors.lastname: Mathieu
authors.forename: A A
authors.initials: AA
authors.lastname: Rached
authors.forename: M
authors.initials: M
authors.lastname: Beaugrand
authors.forename: C
authors.initials: C
authors.lastname: Chastang
mesh_terms: 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