title: Transcatheter chemoembolization for unresectable hepatocellular carcinoma and comparison of five staging systems.
abstract: OBJECTIVE
  We compared the ability of five staging system to predict survival in patients with hepatocellular carcinoma (HCC) treated with chemoembolization.
  
  
  METHODS
  The study subjects were 214 patients with HCC treated with repeated chemoembolization alone using cisplatin and lipiodol. Predictors of survival were assessed by multivariate analysis. Before chemoembolization was carried out, the modified Japan Integrated Staging (m-JIS), Japan Integrated Staging (JIS score), Barcelona (BCLC) stage, Liver Cancer Study Group of Japan/Tumor-Node-Metastasis (LCSGJ/TNM) and Italian score (CLIP score) were checked. To validate the prognostic value of these staging systems, the survival curve was obtained and analyzed by the Kaplan-Meier method. Discriminatory ability and predictive power were compared using Akaike's information criterion (AIC) score and the likelihood ratio (LR) χ(2) .
  
  
  RESULTS
  Overall survival was 1 year in 82.9%, 3 years in 39.9% and 5 years in 15.1%. Multivariate analysis identified more than 90% lipiodol accumulation (grade I) after the first chemoembolization (P = 0.001), absence of portal vein tumor thrombosis (PVTT) (P < 0.001) and liver damage A (P = 0.012) as independent determinants of survival. AIC score and the LR χ(2) showed superior predictive power of the m-JIS system in 95 patients with grade I accumulation of lipiodol after first chemoembolization.
  
  
  CONCLUSIONS
  The discriminate ability of the m-JIS score is substantially better than those of other staging systems and has better prognostic predictive power in patients with grade I accumulation of lipiodol after first chemoembolization.
authors.affiliation: Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Tomokazu
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authors.lastname: Kawaoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Shintaro
authors.initials: S
authors.lastname: Takaki
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Katamura
authors.forename: Akira
authors.initials: A
authors.lastname: Hiramatsu
authors.forename: Koji
authors.initials: K
authors.lastname: Waki
authors.forename: Shoichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Koji
authors.initials: K
authors.lastname: Kamada
authors.forename: Mikiya
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authors.lastname: Kitamoto
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Masaki
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authors.lastname: Ishikawa
authors.forename: Masashi
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authors.lastname: Hieda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kakizawa
authors.forename: Junko
authors.initials: J
authors.lastname: Tanaka
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama