The prognosis and survival analysis according to seven staging systems of hepatocellular carcinoma following curative resection

Abstract

BACKGROUND/AIMS: Several staging systems have been introduced to predict the prognosis of hepatocellular carcinoma (HCC). The aim of current study was to analyze the clinicopathologic prognostic variables and calculate overall survival and disease-free survival rates to compare the prognosis of HCC patients treated with curative resection according to seven different staging systems.

METHODOLOGY: A retrospective study of 163 patients with HCC who underwent curative resection in our department between January 1998 and December 2001 was conducted. The clinicopathological prognostic factors were identified by univariate analysis. The patients were classified according to the TNM (AJCC 5th and 6th edition), Okuda, BCLC (Barcelona Clinic Liver Cancer), JIS (Japanese Integrated System), CLIP (Cancer of Liver Italian Program), and GRETCH (Group d'Etude de Traitement du Carcinoma Hepatocellullarire) systems. The overall survival and disease free survival were calculated using the Kaplan-Meier method.

RESULTS: Univariate analysis of clinicopathologic prognostic factors indicated that tumor size, satellite nodules, portal vein invasion, bile duct invasion, microvessel invasion, differentiation and albumin level were statistically significant factors for survival. Mean survival time was 72.3+/-3.0 months. The overall survival curve and the disease-free survival curve applied to TNM (AJCC 6th edition) staging clearly show the difference in survival.

CONCLUSIONS: The TNM (AJCC 6th edition) staging system provides the most effective means of assessing the prognosis of patients following curative resection of HCC.