title: Optimal staging system for predicting the prognosis of patients with hepatocellular carcinoma in China: a retrospective study.
abstract: Several staging systems have been developed to evaluate patients with hepatocellular carcinoma (HCC), including the China Staging System (CS), the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system, and seventh edition; the Barcelona Clinic Liver Cancer (BCLC) staging system, and Cancer of the Liver Italian Program (CLIP) staging system. The optimal staging system for to evaluate patients in China with HCC has not been determined. This study was designed to determine the optimal staging system for predicting patient prognosis by comparing the performances of these four staging systems in a cohort of Chinese patients with HCC.
  
  
  
  This study enrolled 307 consecutive Chinese patients with HCC in Shandong Province. The performances of the CS, TNM, BCLC, and CLIP staging systems were compared and ranked using a concordance index. Predictors of survival were identified using univariate and multivariate Cox model analyses.
  
  
  
  The mean overall survival of the patient cohort was 12.08 ± 11.87 months. Independent predictors of survival included tumor size, number of lesions, tumor thromboses, cirrhosis, serum albumin level and serum total bilirubin level. Compared with the other three staging systems, the CS staging system showed optimal performance as an independent predictor of patient survival. The BCLC staging system showed the poorest performance; its treatment algorithm was not suitable for patients in this study.
  
  
  
  CS was the most suitable staging system for predicting survival of patients with HCC in China.
authors.affiliation: Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Lihui
authors.initials: L
authors.lastname: Su
authors.affiliation: Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
authors.affiliation: Department of Hepatobiliary Surgery, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Zongli
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Xiuguo
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Xuting
authors.initials: X
authors.lastname: Zhi
authors.affiliation: Department of Intervention, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Intervention, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Qingliang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, Shandong University, Jinan, 250012, China.
authors.forename: Chongqi
authors.initials: C
authors.lastname: Jia
authors.affiliation: Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Wenna
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China.
authors.forename: Yanqiu
authors.initials: Y
authors.lastname: Yue
authors.affiliation: Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China. yanjinggao@aliyun.com.
authors.forename: Yanjing
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250012, China. drcbq@163.com.
authors.forename: Baoquan
authors.initials: B
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D002648:Child; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden; D055815:Young Adult
keywords: Hepatocellular carcinoma; Independent predictors; Overall survival; Prognosis; Staging system