title: Validation of models in patients with hepatocellular carcinoma: comparison of Hong Kong Liver Cancer with Barcelona Clinic Liver Cancer staging system in a Chinese cohort.
abstract: OBJECTIVE
  Accurate staging information is necessary to determine the prognosis of patients with hepatocellular carcinoma (HCC) and to guide subsequent patient management. This study aims to investigate the prognostic performance of the Hong Kong Liver Cancer (HKLC) classification in a Chinese cohort of HCC patients.
  
  
  METHODS
  A total of 668 HCC patients between 2003 and 2012 were included. Performances of the HKLC and the Barcelona Clinic Liver Cancer (BCLC) system were compared using Akaike information criterion (AIC), concordance-index (c-index), and area under the receiver operating characteristic curve (AUC). Independent prognostic factors of survival were identified using univariate and multivariate analyses.
  
  
  RESULTS
  Independent predictors of survival were Child-Pugh grade (P=0.009), lactate dehydrogenase (P<0.001) and albumin (P=0.001) levels, tumor location (P=0.032), tumor number (P<0.001), tumor size (P<0.001), and vascular invasion (P<0.001). Discriminatory ability was shown to be better for HKLC (AUC at 1, 3, and 5 years were 0.740, 0.695, and 0.615, respectively) than BCLC (AUC at 1, 3, and 5 years were 0.622, 0.569, and 0.548, respectively). On the basis of AIC and c-index, HKLC had a higher predictive power for survival (AIC=4709.480, c-index=0.805) than BCLC (AIC=4852.708, c-index=0.717).
  
  
  CONCLUSIONS
  In our selected patient population, whose main etiology was hepatitis B, the HKLC system was more suitable for predicting prognosis in a Chinese cohort of HCC patients than the BCLC classification.
authors.affiliation: aDepartment of Hepatopancreatobiliary Surgery, Drum Tower Hospital, Medical School of Nanjing University bDepartment of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Yan
authors.forename: Xu
authors.initials: X
authors.lastname: Fu
authors.forename: Chuang
authors.initials: C
authors.lastname: Cai
authors.forename: Xuejian
authors.initials: X
authors.lastname: Zi
authors.forename: Hui
authors.initials: H
authors.lastname: Yao
authors.forename: Yudong
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D055815:Young Adult