title: Comparative performances of staging systems for early hepatocellular carcinoma.
abstract: BACKGROUND
  Several staging systems for patients with hepatocellular carcinoma (HCC) have been proposed, but studies of their prognostic accuracy have yielded conflicting conclusions. Stratifying patients with early HCC is of particular interest because these patients may derive the greatest benefit from intervention, yet no studies have evaluated the comparative performances of staging systems in patients with early HCC.
  
  
  METHODS
  A retrospective cohort study was performed using data on 379 patients who underwent liver resection or liver transplantation for HCC at six major hepatobiliary centres in the USA and Europe. The staging systems evaluated were: the Okuda staging system, the International Hepato-Pancreato-Biliary Association (IHPBA) staging system, the Cancer of the Liver Italian Programme (CLIP) score, the Barcelona Clinic Liver Cancer (BCLC) staging system, the Japanese Integrated Staging (JIS) score and the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system, 6th edition. A recently proposed early HCC prognostic score was also evaluated. The discriminative abilities of the staging systems were evaluated using Cox proportional hazards models and the bootstrap-corrected concordance index (c).
  
  
  RESULTS
  Overall survival of the cohort was 74% at 3 years and 52% at 5 years, with a median survival of 62 months. Most systems demonstrated poor discriminatory ability (P > 0.05 on Cox proportional hazards analysis, c approximately 0.5). However, the AJCC/UICC system clearly stratified patients (P < 0.001, c = 0.59), albeit only into two groups. The early HCC prognostic score also clearly stratified patients (P < 0.001, c = 0.60) and identified three distinct prognostic groups.
  
  
  CONCLUSIONS
  The early HCC prognostic score is superior to the AJCC/UICC staging system (6th edition) for predicting the survival of patients with early HCC after liver resection or liver transplantation. Other major HCC staging systems perform poorly in patients with early HCC.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Hugo P
authors.initials: HP
authors.lastname: Marques
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Nadia
authors.initials: N
authors.lastname: Russolillo
authors.forename: Benjamin
authors.initials: B
authors.lastname: Philosophe
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik