Newly Proposed Prognostic Scoring System (SLIDE) for HCC
Background: The long-term prognosis of hepatocellular carcinoma (HCC) remains poor and the prediction of survival is often difficult because of the limited liver function and frequent recurrence of HCC in most patients. Therefore, a prognostic classification of HCC should account for both tumor-related variables and liver function.
Methods: The value of reported prognostic factors for HCC was assessed and a new prognostic classification was established called the 'SLiDe' scoring system (S, stage; Li, liver damage; De, des-γ-carboxy prothrombin) using 'stage' and 'liver damage' of the recently revised 4th edition of the Japanese staging system edited by the Liver Cancer Study Group of Japan, and the serum level of des-γ-carboxy prothrombin (DCP) in 177 patients with HCC.
Results: Univariate analysis identified Child-Pugh stage, liver damage, tumor morphology, portal vein thrombosis, stage, serum level of α-fetoprotein (AFP), serum level of DCP, and initial treatment as significant prognostic factors. Of these, liver damage, stage, and serum level of DCP remained independent predictive factors of survival after multivariate prognostic analysis using the proportional hazards regression model. Therefore, a new prognostic scoring system (SLiDe scoring system) was derived that assigned a linear score (0/1/2/3) to these three covariates. This SLiDe scoring system was statistically a better model for predicting outcome in the present study population than the Cancer of the Liver Italian Program (CLIP) and the Japan Integrated Staging (JIS) scoring systems, as judged by the Akaike Information Criteria.
Conclusion: The SLiDe scoring system is useful for the assessment of the prognosis of patients with HCC as long as the Japanese staging system is used, although this uses parameters such as the indocyanine green retention test and DCP, which are not examined routinely in every part of the world.Therefore, the proposed classification should be further validated in other large study populations.
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, particularly in southern Africa and east Asian countries. Recent progress in imaging techniques such as arteriography, computed tomography, ultrasonography, and magnetic resonance imaging have allowed the diagnosis of HCC at an early stage, and advances in treatment modalities such as hepatic resection, percutaneous ethanol injection therapy, and transcatheter arterial chemoembolization have improved the prognosis. However, the long-term prognosis remains poor and the prediction of survival is often difficult because of the limited liver function and frequent recurrence of HCC in most patients.
The Japanese staging system generally used for HCC in Japan (3rd edition) was revised considerably by the Liver Cancer Study Group of Japan (LCSGJ) in November 2000. Ueno et al. reported recently that the 4th edition had a higher stratification value than the 3rd edition. They also suggested that the addition to the latest edition of another scoring system based on its original definitions of 'tumor staging' and 'liver damage' would be highly beneficial for evaluating the prognosis of patients with HCC. For this, the relative risks between 'tumor staging' and 'liver damage' in the 4th edition should be analyzed.
In the present study, we assessed the value of the reported prognostic factors for HCC. We then established a new prognostic classification (the SLiDe scoring system: S, stage; Li, liver damage; De, des-γ-carboxy prothrombin) that included both tumor characteristics and liver function using 'stage' and 'liver damage' of the 4th edition of the Japanese staging system.
Background: The long-term prognosis of hepatocellular carcinoma (HCC) remains poor and the prediction of survival is often difficult because of the limited liver function and frequent recurrence of HCC in most patients. Therefore, a prognostic classification of HCC should account for both tumor-related variables and liver function.
Methods: The value of reported prognostic factors for HCC was assessed and a new prognostic classification was established called the 'SLiDe' scoring system (S, stage; Li, liver damage; De, des-γ-carboxy prothrombin) using 'stage' and 'liver damage' of the recently revised 4th edition of the Japanese staging system edited by the Liver Cancer Study Group of Japan, and the serum level of des-γ-carboxy prothrombin (DCP) in 177 patients with HCC.
Results: Univariate analysis identified Child-Pugh stage, liver damage, tumor morphology, portal vein thrombosis, stage, serum level of α-fetoprotein (AFP), serum level of DCP, and initial treatment as significant prognostic factors. Of these, liver damage, stage, and serum level of DCP remained independent predictive factors of survival after multivariate prognostic analysis using the proportional hazards regression model. Therefore, a new prognostic scoring system (SLiDe scoring system) was derived that assigned a linear score (0/1/2/3) to these three covariates. This SLiDe scoring system was statistically a better model for predicting outcome in the present study population than the Cancer of the Liver Italian Program (CLIP) and the Japan Integrated Staging (JIS) scoring systems, as judged by the Akaike Information Criteria.
Conclusion: The SLiDe scoring system is useful for the assessment of the prognosis of patients with HCC as long as the Japanese staging system is used, although this uses parameters such as the indocyanine green retention test and DCP, which are not examined routinely in every part of the world.Therefore, the proposed classification should be further validated in other large study populations.
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, particularly in southern Africa and east Asian countries. Recent progress in imaging techniques such as arteriography, computed tomography, ultrasonography, and magnetic resonance imaging have allowed the diagnosis of HCC at an early stage, and advances in treatment modalities such as hepatic resection, percutaneous ethanol injection therapy, and transcatheter arterial chemoembolization have improved the prognosis. However, the long-term prognosis remains poor and the prediction of survival is often difficult because of the limited liver function and frequent recurrence of HCC in most patients.
The Japanese staging system generally used for HCC in Japan (3rd edition) was revised considerably by the Liver Cancer Study Group of Japan (LCSGJ) in November 2000. Ueno et al. reported recently that the 4th edition had a higher stratification value than the 3rd edition. They also suggested that the addition to the latest edition of another scoring system based on its original definitions of 'tumor staging' and 'liver damage' would be highly beneficial for evaluating the prognosis of patients with HCC. For this, the relative risks between 'tumor staging' and 'liver damage' in the 4th edition should be analyzed.
In the present study, we assessed the value of the reported prognostic factors for HCC. We then established a new prognostic classification (the SLiDe scoring system: S, stage; Li, liver damage; De, des-γ-carboxy prothrombin) that included both tumor characteristics and liver function using 'stage' and 'liver damage' of the 4th edition of the Japanese staging system.
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