New Staging Model for Radiation-based Hepatocellular Carcinoma Treatment: A National Multicenter Study

Abstract

Background and aims: The study aimed to create a new staging model for radiotherapy-based treatment for prognostic hepatocellular carcinoma (HCC) classification.

Methods: The training cohort comprised 658 patients receiving stereotactic body radiotherapy and external validation cohort comprised 533 patients receiving three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. We established a modified staging system as follows: stage I, solitary nodule without macrovascular invasion, or 2-3 nodules no more than 3.0 cm apart, and performance status (PS) 0-2 (Ia: ALBI-1 grade; Ib: ALBI-2 or 3 grade); stage II: 2-3 nodules with any one nodule more than 3.0-cm apart, or ≥4 nodules, and performance status 0-2 (IIa: ALBI-1 grade; IIb: ALBI-2 grade); stage III: macrovascular invasion, regional lymph node metastasis or distant metastasis, and performance status 0-2 (IIIa: ALBI-1 grade; IIIb: ALBI-2 grade); stage IV: performance status 3-4, or performance status 0-2 with ALBI-3 grade. We analyzed long-term overall survival based on different stages.

Results: The staging model showed an excellent ability to discriminate patients according to four stages and seven substages with notably different curves in the training and validation cohort. The median survival decreased from stages I to IV with 63.0 months in stage I (not reached in Ia, and 53.0 months in Ib), 24.0 months in stage II (28.0 months in IIa, and 22.0 months in IIb), 11.0 months in stage III (18.0 months in IIIa, and 9.0 months in IIIb), and less than 9.0 months in stage IV in the training cohort.

Conclusions: The modified staging model may provide an alternative for clinical radiation oncologists.

Keywords: Hepatocellular carcinoma; Overall survival; Radiotherapy; Staging system; Stereotactic body radiotherapy.

Fig. 1. (A) Four stages in the training cohort; (B) Seven substages in the training cohort.

Fig. 2. (A) Four stages in the external validation cohort; (B) Six substages in the external validation cohort; (C) Seven substages in the external validation cohort.

Fig. 3. Time-dependent (months) receiver operating characteristic curves: (A) in the training cohort; (B) in the external validation cohort; (C) in the entire cohort.