Establishment of a Disease-Specific Graded Prognostic Assessment for Hepatocellular Carcinoma Patients with Spinal Metastasis

Abstract

Background/aims: Hepatocellular carcinoma (HCC) patients with spinal metastasis (SM) show heterogeneous lengths of survival. In this study, we develop and propose a graded prognostic assessment for HCC patients with SM (HCC-SM GPA).

Methods: We previously reported the outcomes of 192 HCC patients with SM who received radiotherapy from April 1992 to February 2012. Prognostic factors that significantly affected survival in that study were used to establish the HCC-SM GPA. Validation was performed using an independent cohort of 63 patients recruited from September 2011 to March 2016.

Results: We developed the HCC-SM GPA using the following factors: Eastern Cooperative Oncology Group performance status (0-2, 0 point; 3-4, 1 point), controlled primary HCC (yes, 0 point; no, 2 points), and extrahepatic metastases other than bone (no, 0 point; yes, 1 point). Patients were stratified into low (GPA=0), intermediate (GPA=1 to 2), and high risk (GPA=3 to 4). When applied to the validation cohort, the HCC-SM GPA determined median survival durations of 13.6, 4.8, and 2.6 months and 1-year overall survival rates of 58.3%, 17.8%, and 7.3% for the low-, intermediate-, and high-risk patient groups, respectively (p<0.001).

Conclusions: Our newly proposed HCC-SM GPA successfully predicted survival outcomes.

Keywords: Carcinoma, hepatocellular; Graded prognostic assessment; Spinal metastasis; Survival.

Fig. 1

Survival outcomes in the training group according to the graded prognostic assessment for hepatocellular carcinoma patients with spinal metastasis (HCC-SM GPA). The risk groups were defined as follows: low risk group, GPA score 0; intermediate risk group, GPA scores 1 to 2; and high risk group, GPA scores 3 to 4. Overall survival differed among all subgroups (p<0.001), between the low-risk and intermediate-risk groups (p=0.001), and between the intermediate-risk and high-risk groups (p=0.002). RT, radiotherapy.

Fig. 2

Survival outcomes in the validation group according to the graded prognostic assessment for hepatocellular carcinoma patients with spinal metastasis (HCC-SM GPA). The risk groups were defined as follows: low-risk group, GPA score 0; intermediate-risk group, GPA scores 1 to 2; and high-risk group, GPA scores 3 to 4. Overall survival differed among all subgroups (p<0.001), between the low-risk and intermediate-risk groups (p=0.014), and between the intermediate-risk and high-risk groups (p=0.009). RT, radiotherapy.