Comparison of staging systems to predict survival in hepatocellular carcinoma.
OBJECTIVE
Some new staging systems in hepatocellular carcinoma (HCC) have been described in the last years. The aim of this study was to compare the survival-predicting capacity of some variables and the prognostic classifications.


METHODS
Demographic, clinical, analytical variables and tumour characteristics were collected in a study including 115 patients with HCC. Predictors of survival were identified using the Kaplan-Meier test and the Cox model. Comparison between different staging systems was carried out.


RESULTS
The 1-, 2- and 3-year estimated survival was 65%, 45% and 30%, respectively. Child-Pugh score and alpha-fetoprotein level greater than 400 UI/l were independent predictors of survival in the Cox model. Although all systems correctly differentiated between patients regarding survival (Kaplan-Meier, log rank < 0.05 for all), the Barcelona Clinic Liver Cancer (BCLC) showed a better discriminatory ability than the other evaluated scores. In addition, the independent homogenizing ability and stratification value of BCLC was better than that of other systems. On the contrary, model for end-stage liver disease (MELD) showed the worst results.


CONCLUSIONS
Child-Pugh score and alpha-fetoprotein levels were the only independent predictors of survival in patients with HCC. Child-Pugh score showed a better prediction value for survival when compared with MELD. BCLC is more accurate than the other prognostic models evaluated in this investigation.
Pascual
Sonia
S
Liver Unit, Hospital General Universitario de Alicante, Alicante, Spain. pascual_son@gva.es
Zapater
Pedro
P
Such
José
J
García-Herola
Antonio
A
Sempere
Laura
L
Irurzun
Javier
J
Palazón
José María
JM
Carnicer
Fernando
F
Pérez-Mateo
Miguel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009367:Neoplasm Staging / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins