Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver
Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores. The majority of the patients had viral hepatitis as the underlying liver disease (100% in the derivation cohort and 85% in the validation cohort). The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha-fetoprotein. In cross-validation, the coefficients remained Adriamycin largely unchanged between iterations. Observed survival in the validation cohort matched closely with what was predicted by the model. The concordance (c)-statistic for this model (0.77) was superior to that for BCLC (0.71), CLIP (0.70), or JIS (0.70). The score was able to further classify patient survival within each stage of the BCLC classification. Conclusion: A new model to predict survival of HCC patients based on objective parameters PD332991 provides refined prognostication and supplements the BCLC classification. (HEPATOLOGY 2012) Liver cancer is a common yet lethal malignancy globally, claiming nearly
700,000 lives as of 2008. It is the third leading cause of cancer deaths in the world.1 In the U.S., the incidence of hepatocellular carcinoma (HCC) has been reported to have tripled over the past 3 decades2 and, because of the poor survival of these patients, mortality associated with HCC also rose in parallel with Cytidine deaminase the incidence.3 HCC is unique in that survival of patients is determined
not only by the extent of the tumor, but also by the severity of underlying liver dysfunction. In addressing the interrelationship of prognostic factors in HCC, there have been at least seven staging systems developed for HCC. These include the Barcelona Clinic Liver Cancer system (BCLC),4 Cancer of the Liver Italian Program score (CLIP),5, 6 Japan Integrated Staging score (JIS),7 the American Joint Committee on Cancer, Tumor, Node, Metastasis (AJCC TNM),8 Okuda,9 Chinese University Prognostic Index (CUPI),10 and Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire Prognostic classification (GETCH).11 Most of these systems include some measures of the tumor extent and abnormal physiology associated with liver disease. The BCLC staging system has been endorsed by the American Association for the Study of Liver Disease (AASLD) and the European Association for the Study of the Liver (EASL) as a standard staging system in HCC. However, drawbacks of the BCLC system include the use of subjective components, particularly performance status and the Child-Turcott-Pugh score and a wide range of patients’ prognosis within a given category. The overall aim of this study was to develop and validate a multivariate survival model for patients with HCC so as to produce prognostic information that may be standardized.