Dataset Information

Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.

ABSTRACT:

Background

Prognostic assessment in patients with hepatocellular carcinoma (HCC) remains controversial. Using the Italian Liver Cancer (ITA.LI.CA) database as a training set, we sought to develop and validate a new prognostic system for patients with HCC.

Methods and findings

Prospective collected databases from Italy (training cohort, n = 3,628; internal validation cohort, n = 1,555) and Taiwan (external validation cohort, n = 2,651) were used to develop the ITA.LI.CA prognostic system. We first defined ITA.LI.CA stages (0, A, B1, B2, B3, C) using only tumor characteristics (largest tumor diameter, number of nodules, intra- and extrahepatic macroscopic vascular invasion, extrahepatic metastases). A parametric multivariable survival model was then used to calculate the relative prognostic value of ITA.LI.CA tumor stage, Eastern Cooperative Oncology Group (ECOG) performance status, Child-Pugh score (CPS), and alpha-fetoprotein (AFP) in predicting individual survival. Based on the model results, an ITA.LI.CA integrated prognostic score (from 0 to 13 points) was constructed, and its prognostic power compared with that of other integrated systems (BCLC, HKLC, MESIAH, CLIP, JIS). Median follow-up was 58 mo for Italian patients (interquartile range, 26-106 mo) and 39 mo for Taiwanese patients (interquartile range, 12-61 mo). The ITA.LI.CA integrated prognostic score showed optimal discrimination and calibration abilities in Italian patients. Observed median survival in the training and internal validation sets was 57 and 61 mo, respectively, in quartile 1 (ITA.LI.CA score ? 1), 43 and 38 mo in quartile 2 (ITA.LI.CA score 2-3), 23 and 23 mo in quartile 3 (ITA.LI.CA score 4-5), and 9 and 8 mo in quartile 4 (ITA.LI.CA score > 5). Observed and predicted median survival in the training and internal validation sets largely coincided. Although observed and predicted survival estimations were significantly lower (log-rank test, p < 0.001) in Italian than in Taiwanese patients, the ITA.LI.CA score maintained very high discrimination and calibration features also in the external validation cohort. The concordance index (C index) of the ITA.LI.CA score in the internal and external validation cohorts was 0.71 and 0.78, respectively. The ITA.LI.CA score's prognostic ability was significantly better (p < 0.001) than that of BCLC stage (respective C indexes of 0.64 and 0.73), CLIP score (0.68 and 0.75), JIS stage (0.67 and 0.70), MESIAH score (0.69 and 0.77), and HKLC stage (0.68 and 0.75). The main limitations of this study are its retrospective nature and the intrinsically significant differences between the Taiwanese and Italian groups.

Conclusions

The ITA.LI.CA prognostic system includes both a tumor staging-stratifying patients with HCC into six main stages (0, A, B1, B2, B3, and C)-and a prognostic score-integrating ITA.LI.CA tumor staging, CPS, ECOG performance status, and AFP. The ITA.LI.CA prognostic system shows a strong ability to predict individual survival in European and Asian populations.

SUBMITTER: Farinati F

PROVIDER: S-EPMC4846017 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Publications

Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.

Farinati Fabio F Vitale Alessandro A Spolverato Gaya G Pawlik Timothy M TM Huo Teh-la TL Lee Yun-Hsuan YH Frigo Anna Chiara AC Giacomin Anna A Giannini Edoardo G EG Ciccarese Francesca F Piscaglia Fabio F Rapaccini Gian Lodovico GL Di Marco Mariella M Caturelli Eugenio E Zoli Marco M Borzio Franco F Cabibbo Giuseppe G Felder Martina M Sacco Rodolfo R Morisco Filomena F Morisco Filomena F Biasini Elisabetta E Foschi Francesco Giuseppe FG Gasbarrini Antonio A Gasbarrini Antonio A Svegliati Baroni Gianluca G Virdone Roberto R Masotto Alberto A Trevisani Franco F Cillo Umberto U

PLoS medicine 20160426 4

<h4>Background</h4>Prognostic assessment in patients with hepatocellular carcinoma (HCC) remains controversial. Using the Italian Liver Cancer (ITA.LI.CA) database as a training set, we sought to develop and validate a new prognostic system for patients with HCC.<h4>Methods and findings</h4>Prospective collected databases from Italy (training cohort, n = 3,628; internal validation cohort, n = 1,555) and Taiwan (external validation cohort, n = 2,651) were used to develop the ITA.LI.CA prognostic ...[more]

PMID: 27116206

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Dataset Information

Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.

Background

Methods and findings

Conclusions

Publications

Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.

Similar Datasets

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