title: The Chinese classification system compared with TNM staging in prognosis of patients with primary hepatic carcinoma after resection.
abstract: BACKGROUND
  The life expectancy of a patient with primary hepatic carcinoma (PHC) is hard to predict, and it is related to many prognostic factors. The Chinese classification system including five parameters: tumor, vascular thrombosis, lymph node metastasis, distant metastasis and Child-Pugh stage developed in 1999 was adopted by the 8th National Conference on Liver Cancer of the Chinese Anti-Cancer Association in 2001. In this study, the discriminatory ability of the Chinese classification system was compared with that of the TNM staging in patients for resection of PHC, in addition to the evaluation of prognostic value.
  
  
  METHODS
  The data of 246 patients who had undergone resection of PHC from January 1986 to December 2000 (average age, 51 years; male/female ratio, 213/33) were retrospectively studied. Among the 246 patients, 227 were followed up for at least 3 years.
  
  
  RESULTS
  The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates were 55%, 30%, 25%, 20% and 18%, respectively. The Chinese classification system was better than the TNM staging system in predicting survival rate of patients with PHC, as confirmed by survival curves shown by the Kaplain-Meier method. The mean survival time was 155, 70, 39, 16, and 4 months in patients with the Chinese classification stages Ia, Ib, IIa, IIb, and III, respectively. The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates of the Chinese classification system and TNM staging were statistically significant and had a slightly positive relationship. The predictive capacity of the Chinese classification system was confirmed in any two subgroups of patients undergoing operation. COX proportional hazards regression analysis showed that the Chinese classification system was the only independent prognostic factor for survival.
  
  
  CONCLUSIONS
  Taking both tumor extension and liver function into account, we consider that the Chinese classification system making up for the deficiency of UICC TNM staging is more precise in predicting the prognosis of patients with resection of PHC.
authors.affiliation: Department of Oncological Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. sjm418@hzcnc.com
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Sheng
authors.forename: Wen-He
authors.initials: WH
authors.lastname: Zhao
authors.forename: Fu-Sheng
authors.initials: FS
authors.lastname: Wu
authors.forename: Zhi-Min
authors.initials: ZM
authors.lastname: Ma
authors.forename: Yi-Zheng
authors.initials: YZ
authors.lastname: Feng
authors.forename: Xing-Ren
authors.initials: XR
authors.lastname: Zhou
authors.forename: Li-Song
authors.initials: LS
authors.lastname: Teng
mesh_terms: D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008113:Liver Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors