title: Reassessing hepatocellular carcinoma staging in a changing patient population.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) staging systems were developed using data predominantly from patients who had hepatitis and cirrhosis. Given the recent change in prevalence of viral hepatitis and cirrhosis at oncology centers, which has altered the natural history of HCC, we aimed at comparing the accuracy of HCC staging systems in patients with or without hepatitis and cirrhosis.
  
  
  METHODS
  A total of 438 patients were enrolled. Baseline clinicopathologic parameters, Barcelona Clinic Liver Cancer stage, Cancer of the Liver Italian Program score, TNM (6th edition) stage, Okuda stage, and Chinese University Prognostic Index score were prospectively obtained for all patients, and retrospectively analyzed. Kaplan-Meier analysis was used to determine overall survival (OS), Cox regression analyses were performed, and Harrell's Correspondence Index compared the staging systems' ability to predict OS duration. Subgroup analyses of patients with or without hepatitis or cirrhosis were performed.
  
  
  RESULTS
  Median patient OS was 13.9 months; 165 patients (37.7%) had no cirrhosis and 256 patients (58.4%) had no hepatitis. Overall, all staging systems were significantly less predictive of OS in patients who did not have cirrhosis or hepatitis.
  
  
  CONCLUSIONS
  Our results advocate the need to further stratify HCC based on cirrhosis and hepatitis status, which may change patient risk-stratification and, ultimately, treatment decisions.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex., USA.
authors.forename: Ahmed O
authors.initials: AO
authors.lastname: Kaseb
authors.forename: Neeraj N
authors.initials: NN
authors.lastname: Shah
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Hassabo
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Morris
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Yasmin M
authors.initials: YM
authors.lastname: Abaza
authors.forename: Khalid
authors.initials: K
authors.lastname: Soliman
authors.forename: Ju-Seog
authors.initials: JS
authors.lastname: Lee
authors.forename: Jean-Nicholas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Michael
authors.initials: M
authors.lastname: Wallace
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Steven
authors.initials: S
authors.lastname: Curley
authors.forename: James L
authors.initials: JL
authors.lastname: Abbruzzese
authors.forename: Manal M
authors.initials: MM
authors.lastname: Hassan
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology