A new prognostic staging system for hepatocellular carcinoma: value of the biomarker combined Japan integrated staging score.
OBJECTIVE
The Japan Integrated Staging (JIS) score has been reported to have good stratification ability in patients with hepatocellular carcinoma (HCC). However, the JIS score could not estimate malignant grade of HCC. The aim of this study was to evaluate the performance of a new staging system: the biomarker combined JIS (bm-JIS) which includes three tumor markers: alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP and des-gamma-carboxy prothrombin with the conventional JIS score.


METHODS
A total of 1,924 HCC patients were included in this study. We compared their overall survival, the stratification ability and suitability as a prognostic model according to the bm-JIS score and the conventional JIS score.


RESULTS
There were significant differences between the survival curves for all bm-JIS scores. For the conventional JIS scores of 0, 1, 2 and 3, the survival curves differed greatly according to the bm-JIS score (p < 0.0001). The independent homogenizing ability and the stratification value of the JIS score and the bm-JIS score determined by the likelihood ratio test using the Cox proportional hazard regression model showed the bm-JIS score to have a higher value(chi2 = 717.348) than the JIS score (chi2 = 668.91).


CONCLUSIONS
The bm-JIS score showed superior stratification ability and thus was found to be a better predictor of the prognosis than the conventional JIS score, especially for the patients with good prognosis.
Kitai
Satoshi
S
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan. m-kudo@med.kindai.ac.jp
Kudo
Masatoshi
M
Minami
Yasunori
Y
Ueshima
Kazuomi
K
Chung
Hobyung
H
Hagiwara
Satoru
S
Inoue
Tatsuo
T
Ishikawa
Emi
E
Takahashi
Shunsuke
S
Asakuma
Yutaka
Y
Haji
Seiji
S
Osaki
Yukio
Y
Oka
Hiroko
H
Seki
Toshihito
T
Kasugai
Hiroshi
H
Sasaki
Yo
Y
Matsunaga
Takashi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D014408:Biomarkers, Tumor; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007564:Japan; D027806:Lens Plant; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011498:Protein Precursors; D011516:Prothrombin; D016019:Survival Analysis; D000509:alpha-Fetoproteins
D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin