Multicenter Validation Study of a Prognostic Index for Portal Vein Tumor Thrombosis in Hepatocellular Carcinoma
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초록
PurposeWe previously reported on a staging system and prognostic index (PITH) for portal vein tumorthrombosis (PVTT) in hepatocellular carcinoma (HCC) patients treated with radiotherapy(RT) at a single institution. The aim of this study is to validate the PITH staging system usingdata from patients at other institutions and to compare it with other published stagingsystems. Materials and MethodsA total of 994 HCC patients with PVTT who were treated with RT between 1998 and 2011by the Korean Radiation Oncology Group were analyzed retrospectively. All patients werestaged using the Cancer of the Liver Italian Program (CLIP), Japanese Integrated Staging(JIS), Okuda, and PITH staging systems, and survival data were analyzed. The likelihoodratio, Akaike information criteria (AIC), time-dependent receiver operating characteristics,and prediction error curve analysis were used to determine discriminatory ability forcomparison of staging systems. ResultsThe median survival was 9.2 months. Compared with the other staging systems, the PITHscore gave the highest values for likelihood ratio and lowest AIC values, demonstrating thatPITH may be a better prognostic model. Although the values were not significant anddifferences were not exceptional, the PITH score showed slightly better performance withrespect to time-dependent area under curve and integrated Brier score of prediction errorcurve. ConclusionThe PITH staging system was validated in this multicenter retrospective study and showedbetter stratification ability in HCC patients with PVTT than other systems.
Abstract
PurposeWe previously reported on a staging system and prognostic index (PITH) for portal vein tumorthrombosis (PVTT) in hepatocellular carcinoma (HCC) patients treated with radiotherapy(RT) at a single institution. The aim of this study is to validate the PITH staging system usingdata from patients at other institutions and to compare it with other published stagingsystems. Materials and MethodsA total of 994 HCC patients with PVTT who were treated with RT between 1998 and 2011by the Korean Radiation Oncology Group were analyzed retrospectively. All patients werestaged using the Cancer of the Liver Italian Program (CLIP), Japanese Integrated Staging(JIS), Okuda, and PITH staging systems, and survival data were analyzed. The likelihoodratio, Akaike information criteria (AIC), time-dependent receiver operating characteristics,and prediction error curve analysis were used to determine discriminatory ability forcomparison of staging systems. ResultsThe median survival was 9.2 months. Compared with the other staging systems, the PITHscore gave the highest values for likelihood ratio and lowest AIC values, demonstrating thatPITH may be a better prognostic model. Although the values were not significant anddifferences were not exceptional, the PITH score showed slightly better performance withrespect to time-dependent area under curve and integrated Brier score of prediction errorcurve. ConclusionThe PITH staging system was validated in this multicenter retrospective study and showedbetter stratification ability in HCC patients with PVTT than other systems.
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