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. 2018 Jan;15(1):855-862.
doi: 10.3892/ol.2017.7419. Epub 2017 Nov 15.

Comparison of five staging systems in predicting the survival rate of patients with hepatocellular carcinoma undergoing trans-arterial chemoembolization therapy

Zhan-Hong Chen  1   2 , Ying-Fen Hong  1 , Xiangwei Chen  1 , Jie Chen  1 , Qu Lin  1 , Jinxiang Lin  1 , Xing Li  1 , Jing-Yun Wen  1 , Dan-Yun Ruan  1 , Min Dong  1 , Li Wei  1 , Tian-Tian Wang  1 , Ze-Xiao Lin  1 , Xiao-Kun Ma  1 , Dong-Hao Wu  1 , Xiang-Yuan Wu  1 , Ruihua Xu  2
Affiliations

Comparison of five staging systems in predicting the survival rate of patients with hepatocellular carcinoma undergoing trans-arterial chemoembolization therapy

Zhan-Hong Chen et al. Oncol Lett. 2018 Jan.

Abstract

The majority of patients with unresectable hepatocellular carcinoma (HCC) undergo trans-arterial chemoembolization (TACE). However, the prognosis of HCC remains poor. In the present study, five staging systems were compared to predict the survival rate of patients with HCC undergoing TACE treatment. A total of 220 patients with HCC were examined according to the model to estimate survival for hepatocellular carcinoma (MESH), hepatoma arterial embolization prognostic score (HAP), modified HAP (mHAP), performance status combined Japan Integrated Staging system (PSJIS) and tumor-node-metastasis (TNM) staging systems. The endpoints of the study were 3-month survival, 6-month survival, 1-year survival and overall survival (OS) rates. Receiver operating characteristic curve analysis indicated that the area under the curve of MESH, HAP, mHAP, PSJIS and TNM was 0.858, 0.728, 0.690, 0.688 and 0.699, respectively, in predicting 3-month survival rates; 0.822, 0.747, 0.720, 0.722 and 0.715, respectively, in predicting 6-month survival rates and 0.725, 0.664, 0.672, 0.645 and 0.654, respectively, in predicting 1-year survival rates. Discriminatory ability, homogeneity, monotonicity and prognostic stratification ability was evaluated using a likelihood ratio test and Akaike information criterion values among the five staging systems, and revealed that the MESH system was the optimal prognostic staging system for HCC. In conclusion, the results of the present study suggest that the MESH system is the most accurate prognostic staging system of 3-month survival, 6-month survival, 1-year survival and OS rates among the five systems analyzed in patients with HCC who have received TACE treatment.

Keywords: hepatitis B; hepatocellular carcinoma; model to estimate survival for hepatocellular carcinoma; prognosis; trans-arterial chemoembolization.

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Figures

Figure 1.
Figure 1.
Receiver operating characteristic curves of MESH, HAP, mHAP, TNM and PSJIS for predicting 3-month survival. The optimal threshold value of MESH was 3 and the area under the curve of MESH was 0.858 (95% confidence interval, 0.805–0.901; P<0.001). P<0.001 for MESH vs. HAP, mHAP, PSJIS or TNM. MESH, model to estimate survival for hepatocellular carcinoma; HAP, hepatoma arterial embolization prognostic score; mHAP, modified HAP; PSJIS, performance status combined Japan Integrated Staging system; TNM, tumor-node-metastasis.
Figure 2.
Figure 2.
Receiver operating characteristic curves of MESH, HAP, mHAP, TNM and PSJIS for predicting 6-month survival. The optimal threshold value of MESH was 3 and the area under the curve of MESH was 0.822 (95% confidence interval, 0.765–0.870; P<0.001). P<0.01 for MESH vs. HAP, mHAP, PSJIS or TNM. MESH, model to estimate survival for hepatocellular carcinoma; HAP, hepatoma arterial embolization prognostic score; mHAP, modified HAP; PSJIS, performance status combined Japan Integrated Staging system; TNM, tumor-node-metastasis.
Figure 3.
Figure 3.
Receiver operating characteristic curves of MESH, HAP, mHAP, TNM and PSJIS when predicting 1-year survival. The optimal threshold value of MESH was 3 and the area under the curve of MESH was 0.725 (95% confidence interval, 0.661–0.783; P<0.01). P<0.05 for MESH vs. HAP, PSJIS or TNM. MESH, model to estimate survival for hepatocellular carcinoma; HAP, hepatoma arterial embolization prognostic score; mHAP, modified HAP; PSJIS, performance status combined Japan Integrated Staging system; TNM, tumor-node-metastasis.
Figure 4.
Figure 4.
Kaplan-Meier estimator survival curves for patients with advanced HCC based on MESH score. HCC; hepatocellular carcinoma; MESH, model to estimate survival for hepatocellular carcinoma.
Figure 5.
Figure 5.
Kaplan-Meier estimator survival curves for patients with advanced hepatocellular carcinoma based on HAP. HAP, hepatoma arterial embolization prognostic score.
Figure 6.
Figure 6.
Kaplan-Meier estimator survival curves for patients with advanced hepatocellular carcinoma based on mHAP. mHAP, modified hepatoma arterial embolization prognostic score.
Figure 7.
Figure 7.
Kaplan-Meier estimator survival curves for patients with advanced hepatocellular carcinoma based on TNM. TNM, tumor-node-metastasis.
Figure 8.
Figure 8.
Kaplan-Meier estimator survival curves for patients with advanced hepatocellular carcinoma based on PSJIS. PSJIS, performance status combined Japan Integrated Staging system.
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References

    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–132. doi: 10.3322/caac.21338. - DOI - PubMed
    1. GBD 2015 mortality and causes of death collaborators, corp-author. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: A systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1459–1544. doi: 10.1016/S0140-6736(16)31012-1. - DOI - PMC - PubMed
    1. Bruix J, Sherman M, Practice Guidelines Committee. American Association for the Study of Liver Diseases Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–1236. doi: 10.1002/hep.20933. - DOI - PubMed
    1. European Association For Study Of Liver, corp-author; European Organization For Research And Treatment Of Cancer, corp-author. EASL-EORTC clinical practice guidelines: Management of hepatocellular carcinoma. Eur J Cancer. 2012;48:599–641. doi: 10.1016/j.ejca.2011.12.021. - DOI - PubMed
    1. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Solà R, et al. Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomized controlled trial. Lancet. 2002;359:1734–1739. doi: 10.1016/S0140-6736(02)08649-X. - DOI - PubMed