Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of re-staging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive HCC patients treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the ITA.LI.CA prognostic score at restaging was compared with that of the BCLC, HKLC, and CLIP systems. A multivariable Cox survival analysis was performed to identify baseline, restaging or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging 35.3% of patients maintained stable disease, while most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance both in the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging including progressive disease after the first treatment, MELD at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power both in the training and validation cohorts (c-index 0.753 and 0.745, respectively). In conclusion, although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.
Restaging patients with hepatocellular carcinoma before additional treatment decisions: a multicenter cohort study
Vitale, Alessandro
;Farinati, Fabio;Noaro, Giulia;Burra, Patrizia;Benvegnù, Luisa;Frigo, Anna Chiara;Cillo, Umberto
2018
Abstract
Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of re-staging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive HCC patients treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the ITA.LI.CA prognostic score at restaging was compared with that of the BCLC, HKLC, and CLIP systems. A multivariable Cox survival analysis was performed to identify baseline, restaging or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging 35.3% of patients maintained stable disease, while most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance both in the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging including progressive disease after the first treatment, MELD at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power both in the training and validation cohorts (c-index 0.753 and 0.745, respectively). In conclusion, although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.
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