title: Intermediate-stage hepatocellular carcinoma treated with hepatic resection: the NSP score as an aid to decision-making.
abstract: BACKGROUND
  The subgroups of patients with intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) who would truly benefit from hepatic resection (HR) are unknown. An objective point score was established to guide the selection of these patients for HR.
  
  
  METHODS
  In all, 255 consecutive patients with intermediate-stage HCC treated with HR were evaluated retrospectively and included in this study (the training cohort). The variables on overall survival (OS, log-rank test) were investigated and a point score (the NSP score) was developed by using a Cox-regression model and validated in an independent external cohort from another institution (n=169).
  
  
  RESULTS
  The NSP score differentiated two groups of patients (⩽1, >1 point) with distinct prognoses (median OS, 61.3 vs 19.3 months; P<0.001). A high NSP score was associated with increased major adverse events after HR (5.6 vs 13.8%, P=0.027). Its predictive accuracy as determined by the area under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years (AUCs 0.688, 0.739, and 0.732) was greater than the other six staging systems for HCC (0.513-0.677). The findings were supported by the validation cohort.
  
  
  CONCLUSIONS
  The NSP scoring system is more accurate in selecting patients with intermediate-stage HCC for HR.
authors.affiliation: The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.|State Key Laboratory of Oncology in South China, Guangzhou 510060, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Yong-Fa
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.|State Key Laboratory of Oncology in South China, Guangzhou 510060, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou 510060, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.|Department of Ultrasonography of Sun Yat-sen University Cancer Center, Guangzhou 510515, China.
authors.forename: Ru-Hai
authors.initials: RH
authors.lastname: Zou
authors.affiliation: The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.|State Key Laboratory of Oncology in South China, Guangzhou 510060, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Chen
authors.affiliation: The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.|Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.affiliation: The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.|State Key Laboratory of Oncology in South China, Guangzhou 510060, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Shi
authors.affiliation: The Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou 510060, China.|State Key Laboratory of Oncology in South China, Guangzhou 510060, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
authors.forename: Rong-Ping
authors.initials: RP
authors.lastname: Guo
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D012189:Retrospective Studies; D016019:Survival Analysis