title: Applying of pretreatment extent of disease system in patients with hepatocellular carcinoma after curative partial hepatectomy.
abstract: The Pretreatment Extent of Disease System (PRETEXT) was designed for childhood liver tumors. The aim of this study was to confirm the prognostic value of the PRETEXT staging system compared with the currently and commonly used staging systems of hepatocellular carcinoma (HCC) after applying PRETEXT system in patients with HCC who underwent curative partial hepatectomy.Clinical data of consecutive patients who underwent curative partial hepatectomy were collected between February 1st, 2005 to December 30th, 2012 as the primary and internal validation cohort. Similar patients from a western hospital formed an external validation cohort. The predictive accuracy of the PRETEXT system compared with the currently used staging systems was measured by the area under the curve (AUC) on receiver operating characteristic (ROC) curve analysis. Of the 507 patients in the primary cohort, the overall median survival was 52.3 months, and the 1-year, 3-year, and 5-year overall survival rates were 83.0%, 56.8%, and 40.2%, respectively. The multivariate analysis of Cox proportional hazard regression identified INR (p=0.001), microvascular invasion (p=0.042), maximum tumor size (p=0.002) and PRETEXT staging system were independently predictors of overall survival. In the primary cohort, the AUC of the PRETEXT system was 0.702 (95% CI, 0.656 to 0.747), which was higher than the other conventional staging systems for predicting OS of HCC (P<0.01). These findings were confirmed with the internal and external validation cohorts.This study showed that the PRETEXT was a good prognostic staging system for HCC. It performed better than the conventional and commonly used staging systems in predicting survival of patients with HCC after curative partial hepatectomy.
authors.affiliation: Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, China.|Department of Hepatic Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Guoliang
authors.initials: G
authors.lastname: Qiao
authors.affiliation: Liver and Multi-Organ Transplantation Unit, St. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Department of Hepatic Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Liver and Multi-Organ Transplantation Unit, St. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Liver and Multi-Organ Transplantation Unit, St. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Department of Hepatic Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Guanghua
authors.initials: G
authors.lastname: Liu
authors.affiliation: Liver and Multi-Organ Transplantation Unit, St. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Hepatic Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
authors.affiliation: Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult
keywords: PRETEXT system; hepatocellular carcinoma; partial hepatectomy; staging systems