Prognostic sub-classification of intermediate-stage hepatocellular carcinoma: a multicenter cohort study with propensity score analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
There is significant heterogeneity in the clini-
copathological characteristics of intermediate hepatocellu-
lar carcinoma (IHCC). This also translates to treatment as
transarterial chemoembolization (TACE) is used as first-
line therapy for patients with IHCC; however, in Asia liver
resection (LR) is preferred. Prognostic tools are required to
help guide clinicians in deciding treatment options. This
study evaluates the prognostic impact of the Intermediate
Stage Score (ISS) on overall survival (OS) in a large,
multicenter cohort study of patients with IHCC treated with
TACE or surgery LR. Consecutive patients from centers in
Japan, Korea, Italy and the United Kingdom who under-
went TACE or LR between 2001 and 2015 were enrolled.
Propensity score (PS) adjustment was used to remove
residual confounding and applied to LR (n=162) and TACE (
n
=
449) to determine the prognostic significance
of ISS. Among 611 patients, 75 % were men and 25 %
women, with a mean age of 70 years. ISS is a valid
prognostic tool in the BCLC-B population with a median
OS ISS 1–51, 2–38.3, 3–24.3, 4–15.6, 5–16 months
(
p
\
0.0001). ISS was analyzed within each treatment
modality, and this was a valid prognostic score among
those treated with TACE and LR (
p
\
0.001 vs.
p
=
0.008). In the PS-adjusted model, ISS retained its
prognostic utility in TACE and LR groups (p\0.001 vs.p=0.007). ISS optimizes prognostic prediction in IHCC,
reducing clinical heterogeneity, and is a useful tool for
patients treated for TACE or LR.
copathological characteristics of intermediate hepatocellu-
lar carcinoma (IHCC). This also translates to treatment as
transarterial chemoembolization (TACE) is used as first-
line therapy for patients with IHCC; however, in Asia liver
resection (LR) is preferred. Prognostic tools are required to
help guide clinicians in deciding treatment options. This
study evaluates the prognostic impact of the Intermediate
Stage Score (ISS) on overall survival (OS) in a large,
multicenter cohort study of patients with IHCC treated with
TACE or surgery LR. Consecutive patients from centers in
Japan, Korea, Italy and the United Kingdom who under-
went TACE or LR between 2001 and 2015 were enrolled.
Propensity score (PS) adjustment was used to remove
residual confounding and applied to LR (n=162) and TACE (
n
=
449) to determine the prognostic significance
of ISS. Among 611 patients, 75 % were men and 25 %
women, with a mean age of 70 years. ISS is a valid
prognostic tool in the BCLC-B population with a median
OS ISS 1–51, 2–38.3, 3–24.3, 4–15.6, 5–16 months
(
p
\
0.0001). ISS was analyzed within each treatment
modality, and this was a valid prognostic score among
those treated with TACE and LR (
p
\
0.001 vs.
p
=
0.008). In the PS-adjusted model, ISS retained its
prognostic utility in TACE and LR groups (p\0.001 vs.p=0.007). ISS optimizes prognostic prediction in IHCC,
reducing clinical heterogeneity, and is a useful tool for
patients treated for TACE or LR.
Date Issued
2016-09-06
Date Acceptance
2016-08-24
Citation
Medical Oncology, 2016, 33 (114)
ISSN
1559-131X
Publisher
Springer
Journal / Book Title
Medical Oncology
Volume
33
Issue
114
Copyright Statement
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Subjects
Oncology & Carcinogenesis
Publication Status
Published