title: A new prognostic system for hepatocellular carcinoma including recurrent cases: a study of 861 patients in a single institution.
abstract: OBJECTIVE
  To manage hepatocellular carcinoma (HCC) patients surviving for a long term, the treatment strategy for recurrent cancer is as important as that for the initial treatment. However, no prognostic scoring system has been available for patients with HCC recurrence. The purpose of this study was to develop a new staging system for deciding the treatment strategy not only for first-time diagnosed patients but also for recurrent patients.
  
  
  METHODS
  A total of 861 cases diagnosed at our single institution from 1993 to 2003 were included. Overall survival was the only end point. The Cox model was used for multivariate analyses.
  
  
  RESULTS
  As of August 2004, 344 cases (59%) had died. Overall median survival time was 41 months. For multivariate Cox regression analysis, independent predictive factors of survival were the number of recurrences, the Child-Pugh score, 3 nodules less than 3 cm and none of vascular invasion, and the alpha-fetoprotein level. A simple scoring system was thus developed, assigning scores (0/1) to the 4 covariates of the final model. Compared with the other scoring systems, the new scoring system has a greater discriminant ability.
  
  
  CONCLUSIONS
  We concluded that our scoring system can serve as a new prognostic system that reflects the spread of HCC, treatment response, and liver function. It should be very useful as the only method which can be applied for patients with recurrence.
authors.affiliation: Liver Research Center, Rhode Island Hospital/Brown Medical School, Providence, RI 02903, USA. toyama.takashi@gmail.com
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiramatsu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yakushijin
authors.forename: Tsugiko
authors.initials: T
authors.lastname: Oze
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nakanishi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yasumaru
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Mochizuki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kanto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
authors.forename: Akinori
authors.initials: A
authors.lastname: Kasahara
authors.forename: Norio
authors.initials: N
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends