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Sub-classification of advanced-stage hepatocellular carcinoma: A cohort study including 612 patients treated with sorafenib

Sub-classification of advanced-stage hepatocellular carcinoma: A cohort study including 612 patients treated with sorafenib
Yoo J.-J.Chung G.E.Lee J.-H.Nam J.Y.Chang Y.Lee J.M.Lee D.H.Kim H.Y.Cho E.J.Yu S.J.Kim Y.J.Yoon J.-H.
Ewha Authors
Issue Date
Journal Title
Cancer Research and Treatment
1598-2998JCR Link
Cancer Research and Treatment vol. 50, no. 2, pp. 366 - 373
Advanced-stageHepatocellular carcinomaPrognosisSorafenib
Korean Cancer Association
Document Type
Purpose Advanced hepatocellular carcinoma (HCC) is associated with various clinical conditions including major vessel invasion, metastasis, and poor performance status. The aim of this study was to establish a prognostic scoring system and to propose a sub-classification of the Barcelona-Clinic Liver Cancer (BCLC) stage C. Materials and Methods This retrospective study included consecutive patients who received sorafenib for BCLC stage C HCC at a single tertiary hospital in Korea. A Cox proportional hazard model was used to develop a scoring system, and internal validation was performed by a 5-fold cross-validation. The performance of the model in predicting risk was assessed by the area under the curve and the Hosmer-Lemeshow test. Results A total of 612 BCLC stage C HCC patients were sub- classified into strata depending on their performance status. Five independent prognostic factors (Child-Pugh score, α-fetoprotein, tumor type, extrahepatic metastasis, and portal vein invasion) were identified and used in the prognostic scoring system. This scoring system showed good discrimination (area under the receiver operating characteristic curve, 0.734 to 0.818) and calibration functions (both p < 0.05 by the Hosmer-Lemeshow test at 1 month and 12 months, respectively). The differences in survival among the different risk groups classified by the total score were significant (p < 0.001 by the log-rank test in both the Eastern Cooperative Oncology Group 0 and 1 strata). Conclusion The heterogeneity of patients with BCLC stage C HCC requires sub-classification of advanced HCC. A prognostic scoring system with five independent factors is useful in predicting the survival of patients with BCLC stage C HCC. © 2018 by the Korean Cancer Association.
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