Abstract
Purpose
We aimed to validate the performance of the hepatitis B-based Hong Kong Liver Cancer (HKLC) staging system compared with the Barcelona Clinic Liver Cancer (BCLC) staging system in Chinese hepatocellular carcinoma (HCC) patients treated with conventional transarterial chemoembolization (TACE) as the initial treatment.
Materials and Methods
The study was approved by the Institutional Review Boards at all participating centers. This retrospective study included 715 patients with HCC who underwent TACE as the initial treatment between January 2008 and December 2016 at three Chinese institutions. All of the patients calculated HCC stage using 5-substage HKLC (HKLC-5), 9-substage HKLC (HKLC-9), and the BCLC system. Based on overall survival (OS), these three staging systems’ performance on treatment outcome prediction were compared using C statistic, Akaike information criterion (AIC), area under the receiver operating characteristic curve (AUC), linear trend Chi-square, likelihood ratio Chi-square, and calibration plots, respectively.
Results
The median OS was 10.1 months. Compared with the BCLC system, the HKLC system, especially HKLC-9, showed better performance on survival prediction (HKLC-9: C = 0.689, AIC = 6646.162; HKLC-5: C = 0.683, AIC = 6662.663; BCLC: C = 0.680, AIC = 6654.146), homogeneity (likelihood ratio Chi-square: HKLC-9 = 232.38, HKLC-5 = 215.87, and BCLC = 224.39, P < 0.001), and calibration (R2: HKLC-9 = 0.923, HKLC-5 = 0.916, and BCLC = 0.914). HKLC-9 outperformed on AUC at 6-, 12-, and 24-month survival prediction than HKLC-5 and BCLC. BCLC showed better performance on monotonicity (linear trend Chi-square: HKLC-9 = 121.641, HKLC-5 = 117.389, and BCLC = 125.752; P < 0.001).
Conclusions
Combining survival prediction, discrimination, and calibration, the HKLC, especially HKLC-9 system, performed better for Chinese patients treated with TACE than the BCLC system.
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Funding
This study was funded by the National Basic Research Program of China (973 Program #2013CB733800, 2013733803), the National Scientific and Technical Achievement Translation Foundation ([2012]258), the National Natural Science Foundation of China (81441054, 81671796, 81501522), the Jiangsu Provincial Special Program of Medical Science (BL2013029), the Fundamental Research Funds for the Central Universities, and the Scientific Research Innovation Program for College and University Graduates of Jiangsu Province (KYZZ16_0133). Funding sources had no involvement in the financial support for the conduct of the research and preparation of the article.
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Ethical Approval
Our study was approved by the Institutional Review Boards (IRBs) at three participating centers. The requirement to obtain informed consent was waived due to the retrospective nature.
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The requirement to obtain informed consent was waived due to the retrospective nature of this study.
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Zhong, BY., Ni, CF., Yin, GW. et al. Multicentric Assessment of the Hong Kong Liver Cancer Staging System in Chinese Patients Following Transarterial Chemoembolization. Cardiovasc Intervent Radiol 41, 1867–1876 (2018). https://doi.org/10.1007/s00270-018-2023-z
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DOI: https://doi.org/10.1007/s00270-018-2023-z