title: Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization.
abstract: OBJECTIVE
  To compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 ((90)Y) radioembolization.
  
  
  METHODS
  During the period 2004-2011, 428 patients with HCC were treated with (90)Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival.
  
  
  RESULTS
  When tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34-0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44-0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40-0.89), absence of ascites (HR, 0.56; CI, 0.40-0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55-0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50-0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51-0.86).
  
  
  CONCLUSIONS
  CLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after (90)Y radioembolization.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.affiliation: Department of Medicine, Division of Hematology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.affiliation: Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Michael
authors.initials: M
authors.lastname: Vouche
authors.affiliation: Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.affiliation: Department of Medicine, Division of Hematology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ali
authors.initials: A
authors.lastname: Habib
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611; Department of Medicine, Division of Hematology and Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611. Electronic address: r-salem@northwestern.edu.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes