Development of a prognostic scoring system for resectable hepatocellular carcinoma.
OBJECTIVE
To develop a prognostic scoring system for overall survival (OS) of patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC).


METHODS
Consecutive patients who underwent curative LR for HCC between 2000 and 2013 were identified. The series was randomly divided into a training and a validation set. A multivariable Cox model for OS was fitted to the training set. The beta coefficients derived from the Cox model were used to define a prognostic scoring system for OS. The survival stratification was then tested, and the prognostic scoring system was compared with the European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) surgical criteria by means of Harrell's C statistics.


RESULTS
A total of 917 patients were considered. Five variables independently correlated with post-LR survival: Model for End-stage Liver Disease score, hepatitis C virus infection, number of nodules, largest diameter and vascular invasion. Three risk classes were identified, and OS for the three risk classes was significantly different both in the training (P < 0.0001) and the validation set (P = 0.0002). Overall, 69.4% of patients were in the low-risk class, whereas only 37.8% were eligible to surgery according to EASL/AASLD. Survival of patients in the low-risk class was not significantly different compared with surgical indication for EASL/AASLD guidelines (77.2 mo vs 82.5 mo respectively, P = 0.22). Comparison of Harrell's C statistics revealed no significant difference in predictive power between the two systems (-0.00999, P = 0.667).


CONCLUSIONS
This study established a new prognostic scoring system that may stratify HCC patients suitable for surgery, expanding surgical eligibility with respect to EASL/AASLD criteria with no harm on survival.
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Carlo
C
Sposito
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Stefano
S
Di Sandro
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Federica
F
Brunero
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Vincenzo
V
Buscemi
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Carlo
C
Battiston
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Andrea
A
Lauterio
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Marco
M
Bongini
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Luciano
L
De Carlis
Carlo Sposito, Carlo Battiston, Marco Bongini, Vincenzo Mazzaferro, Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, 20133 Milan, Italy.
Vincenzo
V
Mazzaferro
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000601:surgery*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012955:Societies, Medical; D016896:Treatment Outcome; D014481:United States
Hepatocellular carcinoma; Liver cirrhosis; Liver resection; Prognosis; Survival study
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