title: The Charlson Comorbidity Index is an Independent Prognostic Factor for Treatment-Naïve Hepatocellular Carcinoma Patients with Extrahepatic Metastases.
abstract: OBJECTIVE
  This study aimed to investigate the association between comorbidity, anti-cancer treatment, and overall survival in patients with hepatocellular carcinoma (HCC) with extrahepatic metastases.
  
  
  METHODS
  We retrospectively analyzed data from 57 patients diagnosed as having treatment-naïve stage IV HCC with extrahepatic metastases between 2007 and 2010. Comorbidity was assessed using two scoring systems, the Charlson comorbidity index (CCI) and the Kaplan-Feinstein index. Associations between comorbidity, demographic variables, treatment modality, and overall survival were analyzed.
  
  
  RESULTS
  Univariate analysis showed that a CCI of ≥ 2 (P = 0.017), an Okuda score of II/III (P = 0.026), and the use of anti-cancer therapy (P = 0.039) was associated with overall survival. Fewer patients with a CCI of ≥ 2 received treatment (P < 0.001), and anti-cancer treatment of any modality did not show a survival benefit in these patients (P = 0.174). The multivariate analysis showed that a CCI of ≥ 2 was the only independent prognostic factor for overall survival (P = 0.043).
  
  
  CONCLUSIONS
  The pre-treatment comorbidity status played an important role in overall survival because of its association with the administration of anti-cancer therapy. Therefore, comprehensive evaluation of comorbidities before treatment is recommended for HCC patients with extrahepatic metastases.
authors.forename: Yueh-shih
authors.initials: YS
authors.lastname: Chang
authors.forename: Jen-seng
authors.initials: JS
authors.lastname: Huang
authors.forename: Cho-li
authors.initials: CL
authors.lastname: Yen
authors.forename: Cheng-hsu
authors.initials: CH
authors.lastname: Wang
authors.forename: Chien-hong
authors.initials: CH
authors.lastname: Lai
authors.forename: Tsung-han
authors.initials: TH
authors.lastname: Wu
authors.forename: Yii-jeng
authors.initials: YJ
authors.lastname: Lan
authors.forename: Pei-hung
authors.initials: PH
authors.lastname: Chang
authors.forename: Kun-yun
authors.initials: KY
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D017115:Catheter Ablation / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents