Study Of The Prognostic Value Of Different Staging Of Hepatocellular Carcinoma In Patients With Hepatectomy

Background and purpose:The reasonable staging of hepatocellular carcinoma(HCC)is extreme critical for predicting the prognosis of patients with hepatocellular carcinoma,selecting treatment methods and evaluating the therapeutic effect.At present,more than ten liver cancer staging have been proposed in the world,including the Eastern staging,Okuda staging,TNM staging,Cancer of the Liver Italian Program(CLIP)scoring,Barcelona clinic liver cancer(BCLC)staging,Chines University Prognostic Index(CUPI),Japan Integrated Staging(JIS)scoring and Hong Kong liver cancer staging(HKLC),etc.These staging systems have been proved to have a good ability to differentiate the overall survival of patients with HCC.However,there have been many controversies about which prognostic staging system is the best.Based on the characteristics of HCC patients in China,this study evaluated the prognostic ability of the Eastern staging,JIS scoring,BCLC staging,Okuda staging,CLIP scoring,TNM staging,and HKLC staging for patients with HCC after hepatectomy in China,and discussed their clinical application value in HCC patients in China.Methods:The clinical data and follow-up data of patients with HCC who underwent hepatectomy from January 2011 to September 2021 in Shanghai Changhai Hospital were retrospectively analyzed.All patients were diagnosed as HCC by pathological examination.The survival curve was drawn using the Kaplan-Meier method,and the survival rate among groups was compared by the Log-rank test,and the cumulative survival rate was calculated by the life table method.The COX proportional hazards regression model was used to conduct univariate and multivariate analysis on the indicators that may affect the efficacy and prognosis.The likelihood ratio χ~2(LHR χ~2)test and the line trend χ~2 test were used to jointly evaluate the homogeneity,discriminant ability,and gradient monotonicity of each staging system.The area under receiver operating characteristic curve(AUC)at 1 year,3 years,5 years for each staging system were calculated.To neutralize potential bias when comparing staging systems with different numbers of stages,the results of COX regression were expressed using the Akaike information criterion(AIC).Result:The 1-,3-,and 5-year cumulative survival rates of the 2365 patients with hepatectomy were 84.2%,64.5%,and 52.6%,respectively.Median survival was 65.4 months.The median follow-up time was 47.6 months.The COX regression analysis showed: American Society of Anesthesiologists(ASA)scoring,lymph node metastasis,distant metastasis,tumor without complete capsule,poorly differentiated tumor,Eastern Cooperative Oncology Group(ECOG)status scoring,largest tumor diameter,preoperative AFP level,satellite lesions,number of tumors,macrovascular invasion,microvascular invasion,palliative resection,intraoperative blood transfusion,portal hypertension,hepatitis B virus,cirrhosis,preoperative AST levels,preoperative ALT levels,preoperative albumin levels,and preoperative total bilirubin levels were independent prognostic factors for patients with liver cancer.There was no statistical significance between 3 and 4 in JIS scoring;no statistical significance between 3 and 4,4 and 5 in CLIP scoring;no statistical significance between Ⅳ and V in HKLC staging.The survival rates of Eastern staging,BCLC staging,Okuda staging and TNM staging were compared among the groups,and the differences were statistically significant.The Eastern phase had the best gradient monotonicity(line trend χ~2 = 408.5)and homogeneity(LHR χ~2 = 447.3)and the highest prediction ability(AUCs of 0.776,0.787,and 0.768 at 1,3,and 5 years,respectively).In addition,the Eastern staging was the most informative staging system for predicting survival(AIC =2982.33).Conclusion:The ASA scoring,lymph node metastasis,distant metastasis,tumor without complete capsule,poorly differentiated tumor,ECOG status scoring,largest tumor diameter,preoperative AFP level,satellite lesions,number of tumors,macrovascular invasion,microvascular invasion,palliative resection,intraoperative blood transfusion,portal hypertension,hepatitis B virus,cirrhosis,preoperative AST levels,preoperative ALT levels,preoperative albumin levels,and preoperative total bilirubin levels were independent prognostic factors for patients with liver cancer.In the Chinese liver resection patient population,the Eastern staging was more accurate in predicting the long-term overall survival of patients with resectable HCC than the other six commonly used staging systems.