title: Prognosis of advanced hepatocellular carcinoma: a new stratification of Barcelona Clinic Liver Cancer stage C: results from a French multicenter study.
abstract: BACKGROUND
  Advanced hepatocellular carcinoma (HCC) includes a wide spectrum of tumors and patients' prognosis after treatment is highly variable. Moreover, therapeutic options based on the Barcelona Clinic Liver Cancer (BCLC) staging system algorithm are restricted to one systemic therapy.
  
  
  OBJECTIVE
  To refine the stratification among BCLC C HCC patients by establishing a new simple prognostic score.
  
  
  METHODS
  A regression model based on a BCLC stage C population and validated with an external cohort of BCLC C HCC patients defined the score. It was therefore validated among three external cohorts of BCLC C HCC patients treated with sorafenib.
  
  
  RESULTS
  Five variables had independent prognostic values: the number of nodules, the infiltrating nature of the HCC, α-fetoprotein serum level, Child-Pugh score, and Eastern Cooperative Oncology Group Performance Status grade. They were integrated into a new score named NIACE ranging from 0 to 7, well correlated with survival. With the use of one threshold value, this score enables defining of two populations with different survivals among BCLC C patients and specifically among those treated with sorafenib.
  
  
  CONCLUSIONS
  The NIACE score defines different prognostic subgroups after palliative treatment of HCC. It could be an additional tool for BCLC C HCC before inclusion in clinical trials or for the management of patients. These results must be validated in a prospective study.
authors.affiliation: Departments of aHepato-Gastroenterology bHepatobiliary Surgery cRadiology, Hôpital Saint-Joseph dAlphaBio Laboratory eDepartment of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, Marseille fDepartment of Hepato-Gastroenterology, Centre Hospitalo-Universitaire, Saint-André Bordeaux, Bordeaux gDepartment of Hepato-Gastroenterology and Digestive Oncology, Centre Eugène Marquis, Rennes hDepartment of Hepato-Gastroenterology iINSERM U954, Université de Lorraine, CHU de Nancy, Vandoeuvre les Nancy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Adhoute
authors.forename: Guillaume
authors.initials: G
authors.lastname: Pénaranda
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raoul
authors.forename: Jean F
authors.initials: JF
authors.lastname: Blanc
authors.forename: Julien
authors.initials: J
authors.lastname: Edeline
authors.forename: Guillaume
authors.initials: G
authors.lastname: Conroy
authors.forename: Hervé
authors.initials: H
authors.lastname: Perrier
authors.forename: Bernard
authors.initials: B
authors.lastname: Pol
authors.forename: Olivier
authors.initials: O
authors.lastname: Bayle
authors.forename: Olivier
authors.initials: O
authors.lastname: Monnet
authors.forename: Patrick
authors.initials: P
authors.lastname: Beaurain
authors.forename: Cyril
authors.initials: C
authors.lastname: Muller
authors.forename: Paul
authors.initials: P
authors.lastname: Castellani
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bronowicki
authors.forename: Marc
authors.initials: M
authors.lastname: Bourlière
mesh_terms: D000368:Aged; D000465:Algorithms; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077157:Sorafenib; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib