title: A prognostic index for patients within the intermediate stage of hepatocellular carcinoma.
abstract: OBJECTIVE
  The Barcelona Clinic Liver Cancer algorithm is the most widely used staging system for hepatocellular carcinoma, but the intermediate stage of this classification comprises a very heterogeneous group of patients with different survival probabilities. The aim of our study was to construct a simple prognostic index for identifying subgroups of patients with different prognoses within the intermediate stage.
  
  
  METHODS
  Three-hundred and seven patients were retrospectively analyzed and randomly divided into a training sample (n=205), from which the model was developed, and a test sample (n=102), to independently assess the model's performance.
  
  
  RESULTS
  Four variables were retained in the final multivariate model: hepatic failure, number of nodules, α-fetoprotein, and albumin, with hazard ratios equal to 2.22 (95% confidence interval: 1.52-3.24), 1.47 (1.00-2.18), 2.34 (1.56-3.52), and 1.75 (1.26-2.44), respectively. The score system was derived by summing up the linear weights assigned to the four covariates according to the observed regression coefficients. The score ranged between 4 and 13; to avoid sparse-data bias arising from small numbers within strata, only four categories (4-5, 6-7, 8-9, 10-13) were identified. The prognosis worsened significantly with increasing score and the C-index for discriminatory accuracy was equal to 0.66 (95% confidence interval: 0.60-0.72). The score was validated in the test sample (log-rank test P=0.02). Similar results were found when evaluating the score as a continuous variable.
  
  
  CONCLUSIONS
  The simple prognostic index predicts survival in patients with intermediate-stage hepatocellular carcinoma. This score might help guide treatment selection and patient stratification in clinical studies.
authors.affiliation: aLiver Unit, Department of Transplantation, Division of Hepatology, Cardarelli Hospital bDepartment of Medical Statistics, Second University of Napoli, Naples, Italy.
authors.forename: Giovan Giuseppe
authors.initials: GG
authors.lastname: Di Costanzo
authors.forename: Simona
authors.initials: S
authors.lastname: Signoriello
authors.forename: Raffaella
authors.initials: R
authors.lastname: Tortora
authors.forename: Ciro
authors.initials: C
authors.lastname: Gallo
mesh_terms: D000368:Aged; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D000075462:Serum Albumin, Human; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: C097353:AFP protein, human; C422455:ALB protein, human; D014408:Biomarkers, Tumor; D012709:Serum Albumin; D000509:alpha-Fetoproteins; D000075462:Serum Albumin, Human