Appraisal of a Model to Estimate Survival in Ambulatory Patients with Hepatocellular Carcinoma Classified as Barcelona Clinic Liver Cancer Stage B
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Background/Aims: Patients with an intermediate stage of hepatocellular carcinoma (HCC) represent a highly heterogeneous population; therefore, many models have been proposed to predict the survival of these patients. The aim of this study was to evaluate the prognostic performance of a novel subclassification for tumors classified as Barcelona Clinic Liver Cancer (BCLC) stage B using the Model to Estimate Survival in Ambulatory HCC patients (MESIAH). Methods: This analysis was based on 377 patients with HCC treated at Seoul National University Hospital (training cohort) and 189 patients at the Soonchunhyang University Bucheon Hospital (validation cohort). Four subclassification systems were tested: MESIAH; original BCLC B subclassification (B1, B2, B3, and B4); modified model A (B1, B2, and B3+B4); and modified model B (B1, B2+B3, and B4). Results: Median survival progressively decreased from stage B1 through stages B2 to B3 according to the new MESIAH subclassification (p<0.001). Moreover, significantly different survival among contiguous stages was observed. In the multivariable Cox regression, the MESIAH subclassification was an independent predictor of overall survival (p<0.001). In terms of discrimination and calibration, MESIAH performed better than the original BCLC B subclassification, modified model A and modified model B. Conclusions: The MESIAH model would be an effective tool for stratifying heterogeneous BCLC stage B cancer, and the ability of this model to predict survival is better than that of the other previously proposed models.
Abstract
Background/Aims: Patients with an intermediate stage of hepatocellular carcinoma (HCC) represent a highly heterogeneous population; therefore, many models have been proposed to predict the survival of these patients. The aim of this study was to evaluate the prognostic performance of a novel subclassification for tumors classified as Barcelona Clinic Liver Cancer (BCLC) stage B using the Model to Estimate Survival in Ambulatory HCC patients (MESIAH). Methods: This analysis was based on 377 patients with HCC treated at Seoul National University Hospital (training cohort) and 189 patients at the Soonchunhyang University Bucheon Hospital (validation cohort). Four subclassification systems were tested: MESIAH; original BCLC B subclassification (B1, B2, B3, and B4); modified model A (B1, B2, and B3+B4); and modified model B (B1, B2+B3, and B4). Results: Median survival progressively decreased from stage B1 through stages B2 to B3 according to the new MESIAH subclassification (p<0.001). Moreover, significantly different survival among contiguous stages was observed. In the multivariable Cox regression, the MESIAH subclassification was an independent predictor of overall survival (p<0.001). In terms of discrimination and calibration, MESIAH performed better than the original BCLC B subclassification, modified model A and modified model B. Conclusions: The MESIAH model would be an effective tool for stratifying heterogeneous BCLC stage B cancer, and the ability of this model to predict survival is better than that of the other previously proposed models.
참고문헌 (34)
- Pons F, "Staging systems in hepatocellular carcinoma", HPB(Oxford), 7, pp.35~41 (2005)
- Yu SJ, "A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world : 2010-2016", Clin Mol Hepatol, 22, pp.7~17 (2016)
- Bruix J, "Management of hepatocellular carcinoma: an update", Hepatology, 53, pp.1020~1022 (2011)
- Bolondi L, "Heterogeneity of patients with intermediate(BCLC B)hepatocellular carcinoma : proposal for a subclassification to facilitate treatment decisions", Semin Liver Dis, 32, pp.348~359 (2012)
- Forner A, "Hepatocellular carcinoma", Lancet, 379, pp.1245~1255 (2012)
- D’Avola D, "Prognosis of hepatocellular carcinoma in relation to treatment across BCLC stages", Ann Surg Oncol, 18, pp.1964~1971 (2011)
- Biolato M, "Prognostic ability of BCLC-B subclassification in patients with hepatocellular cvarcinoma undergoing transarterial chemoembolization", Ann Hepatol, 17, pp.110~118 (2018)
- Zhang N, "Incorporation of alpha-fetoprotein(AFP)into subclassification of BCLC C stage hepatocellular carcinoma according to a 5-year survival analysis based on the SEER database", Oncotarget, 7, pp.81389~81401 (2016)
- Kudo M, "Subclassification of BCLC B stage hepatocellular carcinoma and treatment strategies : proposal of modified Bolondi’s subclassification(Kinki Criteria)", Dig Dis, 33, pp.751~758 (2015)
- Yang JD, "Model to estimate survival in ambulatory patients with hepatocellular carcinoma", Hepatology, 56, pp.614~621 (2012)
- Park KW, "Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area", J Gastroenterol Hepatol, 23, pp.467~473 (2008)
- Kim BH, "Validation of a model to estimate survival in ambulatory patients with hepatocellular carcinoma : a single-centre cohort study", Liver Int, 34, pp.e317~e323 (2014)
- Edge SB, "The American Joint Committee on Cancer : the 7th edition of the AJCC cancer staging manual and the future of TNM", Ann Surg Oncol, 17, pp.1471~1474 (2010)
- Heimbach JK, "AASLD guidelines for the treatment of hepatocellular carcinoma", Hepatology, 67, pp.358~380 (2018)
- Jung YK, "BCLC stage B is a better designation for single large hepatocellular carcinoma than BCLC stage A", J Gastroenterol Hepatol, 31, pp.467~474 (2016)
- Bruix J, "Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma", Gastroenterology, 150, pp.835~853 (2016)
- Cho Y, "Survival analysis of single large(>5 cm)hepatocellular carcinoma patients : BCLC A versus B", PLoS One, 11, pp.e0165722~ (2016)
- Kim HC, "Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein", J Vasc Interv Radiol, 24, pp.274~283 (2013)
- Choi JW, "Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus", Eur Radiol, 27, pp.1448~1458 (2017)
- Yoo JJ, "Comparison of the effects of transarterial chemoembolization for advanced hepatocellular carcinoma between patients with and without extrahepatic metastases", PLoS One, 9, pp.e113926~ (2014)
- Ha Y, "Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis", J Gastroenterol Hepatol, 29, pp.787~793 (2014)
- 김준영, "Transarterial chemoembolization versus resection for the intermediate stage hepatocellular carcinoma", Clinical and Molecular Hepatology, 22(2), pp.250~258 (2016), 대한간학회
- Lee EW, "Recent advances in transarterial embolotherapies in the treatment of hepatocellular carcinoma", Clin Mol Hepatol, 23, pp.265~272 (2017)
- Hu HT, "Chemoembolization for hepatocellular carcinoma : multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort", J Vasc Interv Radiol, 22, pp.917~923 (2011)
- Miyayama S, "Superselective conventional transarterial chemoembolization for hepatocellular carcinoma : rationale, technique, and outcome", J Vasc Interv Radiol, 27, pp.1269~1278 (2016)
- 최태원, "The Safety and Clinical Outcomes of Chemoembolization in Child-Pugh Class C Patients with Hepatocellular Carcinomas", Korean Journal of Radiology, 16(6), pp.1283~1293 (2015), 대한영상의학회[DOI]
- Giannini EG, "Application of the intermediate-stage subclassification to patients with untreated hepatocellular carcinoma", Am J Gastroenterol, 111, pp.70~77 (2016)
- Weinmann A, "Survival analysis of proposed BCLC-B subgroups in hepatocellular carcinoma patients", Liver Int, 35, pp.591~600 (2015)
- Wang JH, "Validation and modification of a proposed substaging system for patients with intermediate hepatocellular carcinoma", J Gastroenterol Hepatol, 30, pp.358~363 (2015)
- Yamakado K, "Prognosis of patients with intermediate-stage hepatocellular carcinomas based on the Child-Pugh score : subclassifying the intermediate stage(Barcelona Clinic Liver Cancer stage B)", Jpn J Radiol, 32, pp.644~649 (2014)
- Kamath PS, "The Model for End-Stage Liver Disease (MELD)", Hepatology, 45, pp.797~805 (2007)
- Malinchoc M, "A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts", Hepatology, 31, pp.864~871 (2000)
- Kamath PS, "A model to predict survival in patients with end-stage liver disease", Hepatology, 33, pp.464~470 (2001)
- Dunn W, "MELD accurately predicts mortality in patients with alcoholic hepatitis", Hepatology, 41, pp.353~358 (2005)