| Background and aims:Primary liver cancer (PLC) is the sixth most common cancer and the third leading cause of cancer deaths worldwide. Several staging systems have been developed to evaluate patients with primary liver cancer (PLC), including the China Staging System (CS), the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system, seventh edition; the Barcelona Clinic Liver Cancer (BCLC) staging system, and Cancer of the Liver Italian Program (CLIP) staging system. The optimal staging system for to evaluate patients in China with PLC has not been determined. This study was designed to determine the optimal staging system for predicting patient prognosis by comparing the performances of these four staging systems in a cohort of Chinese patients with PLC and attempted to identify factors independently prognostic of survival in these patients. At the same time, the last but not the least aim was to study the treatments reasonability and benefits for patients outcomes with primary liver cancer.Methods:This study enrolled 354 consecutive Chinese patients with PLC in Shandong Province between January 1,2010, and October 31,2014. Continuous variables were expressed as mean ±standard deviation (SD), and categorical as frequencies and percentage. Survival outcomes were estimated by the Kaplan-Meier method and compared by the log-rank test. The performances of the CS, TNM, BCLC, and CLIP staging systems were compared and ranked using a concordance index:the higher the c-index, the more informative the model was about patient outcomes. Predictors of survival were identified using univariate and multivariate Cox model analyses. All p-values were two-sided, and those less than 0.05 were considered statistically significant.Results:Of the 354 patients with PLC included in the study,281 were male and 73 were female, with a mean age of 55.70±11.00 years. Among the 354 patients,149 (42.1%) had died by the time of the final analysis (January 1,2015) and the mean overall survival of the patient cohort was 11.90±2.04 months. Independent predictors of survival included tumor size, number of lesions, tumor thromboses, ascites, cirrhosis, distant metastasis and serum total bilirubin level. Survival curves were generated by Kaplan-Meier method for each of the four staging systems. Stage groupings of all four staging systems were significantly predictive of OS (p< 0.001 each), although some overlapping of survival curves was observed. Compared with the other three staging systems, the CS staging system showed optimal performance as an independent predictor of patient survival (c-index,0.75; 95% CI,0.71-0.80). The BCLC staging system showed the poorest performance (c-index,0.69; 95% CI, 0.65-0.73), its treatment algorithm was not suitable for patients in this study. There was a significant difference between prognostic ability of the CS staging system compared with BCLC staging system (p= 0.031). In patients with CS stage II PLC, curative therapies, including liver resection (LR) and radiofrequency ablation (RFA) was more beneficial than transarterial chemoembolization and microwave ablation.Conclusions:CS was the most suitable staging system for predicting survival of patients with PLC in China. The poor performance of the BCLC staging system in this cohort suggests its unsuitability for evaluating Chinese patients with PLC. LR and RFA yielded better outcomes than transarterial chemoembolization and microwave ablation in patients with CS stage Ⅱ PLC. |
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