Prognostic sub-classification of intermediate-stage hepatocellular carcinoma: a multicenter cohort study with propensity score analysis

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Title: Prognostic sub-classification of intermediate-stage hepatocellular carcinoma: a multicenter cohort study with propensity score analysis
Authors: Ramaswami, R
Pinato, DJ
Kubota, K
Ishizuka, M
Arizumi, T
Kudo, M
Jang, JW
Pirisi, M
Allara, E
Sharma, R
Item 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.
Issue Date: 6-Sep-2016
Date of Acceptance: 24-Aug-2016
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 (, 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.
Keywords: Oncology & Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine

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