title: Validation of the modified TNM-Izumi classification for hepatocellular carcinoma.
abstract: OBJECTIVE
  The clinical value of the UICC TNM classification and the Izumi TNM modification regarding prognosis after hepatic resection was evaluated.
  
  
  METHODS
  Between January 1993 and December 1998, survival and disease-free survival were analyzed in 53 cirrhotic patients (40 males, 13 females; mean age, 65 years; range, 43-81) who underwent hepatic resection for HCC.
  
  
  RESULTS
  The 1-, 3-, and 5-year overall survivals were: 89%, 54%, and 50%, with disease-free survivals of 70%, 38%, and 28%, respectively. The difference between stages 1 and 2 or stages 3 and 4A using the UICC TNM classification was not significant with respect to survival or disease-free survival. Conversely, the Izumi TNM modification showed a significant difference between each stage with respect to survival and disease-free survival. In a multivariate analysis the lack of micro/macro vascular invasion was predictive of long-term outcome.
  
  
  CONCLUSIONS
  Our results show that the UICC TNM classification for hepatocellular carcinoma is inadequate. The Izumi modified TNM staging system is superior in assessing prognosis for surgical HCC patients.
authors.affiliation: Department of Emergency Surgery, Surgical Oncology, University of Milan, School of Medicine, San Raffaele Scientific Institute, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Staudacher
authors.forename: A
authors.initials: A
authors.lastname: Chiappa
authors.forename: F
authors.initials: F
authors.lastname: Biella
authors.forename: R A
authors.initials: RA
authors.lastname: Audisio
authors.forename: E
authors.initials: E
authors.lastname: Bertani
authors.forename: A P
authors.initials: AP
authors.lastname: Zbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate