title: A new prognostic scoring system involving des-gamma-carboxy prothrombin as a useful marker for predicting prognosis in patients with hepatocellular carcinoma.
abstract: A staging system for hepatocellular carcinoma was reported from Italy (CLIP). In this study, we evaluate the CLIP scoring system and establish a new scoring system for predicting the prognosis of patients with hepatocellular carcinoma. Patients (n=141) who were diagnosed and who underwent initial treatment at our single institution were recruited retrospectively into this study. We evaluated markers for prognosis, using a stratified Cox proportional hazard regression model and Kaplan-Meier survival analysis. CLIP score differentiated patients with different survival experiences by Kaplan-Meier estimated survival analysis. However, with respect the CLIP score, more than two thirds of patients were included in the early stage (CLIP 0-1), and the group with better prognosis than the survival rate of all patients was the only one with CLIP 0. Multivariate analysis revealed that des-gamma-carboxy prothrombin (DCP) >/=100 mAU/ml (relative risk, 2.06; P=0.0218) was statistically significant as a predictor of poor survival. A new prognostic scoring system included DCP classified patients to 6 well-balanced groups (score 0-5). The new prognostic scoring system 0 group (14.9% of the cohort) and the CLIP score 0 group (34.0% of the cohort) had a median survival of 66.9 and 61.6 months. The new prognostic scoring system performs better for prediction of survival than either the CLIP score or the Child-Pugh stage. In conclusion, the described scoring system provides more accurate prognostic information than the CLIP scoring system. It may help physicians decide more appropriate clinical and therapeutic management.
authors.affiliation: First Department of Internal Medicine, Mie University School of Medicine, Tsu, Mie 514-8507, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kawakita
authors.forename: Katsuya
authors.initials: K
authors.lastname: Shiraki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamanaka
authors.forename: Yumi
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Saitou
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Enokimura
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okano
authors.forename: Kazushi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Murata
authors.forename: Koichirou
authors.initials: K
authors.lastname: Yamakado
authors.forename: Kan
authors.initials: K
authors.lastname: Takeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000368:Aged; D015415:Biomarkers; D014408:Biomarkers, Tumor; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000175:diagnosis*; D002470:Cell Survival; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000494:pharmacology*; D011516:Prothrombin / Q000494:pharmacology*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin