This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vauthey, J.-N. Articles by Nagorney, D. M. Search for Related Content PubMed PubMed Citation Articles by Vauthey, J.-N. Articles by Nagorney, D. M. Social Bookmarking                            What's this?

Simplified Staging for Hepatocellular Carcinoma

From the International Cooperative Study Group on Hepatocellular Carcinoma; Departments of Surgical Oncology, Biostatistics and Biomathematics, and Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pathology, Massachusetts General Hospital, Boston, MA; Department of General Surgery, Mayo Clinic, Rochester, MN; and Department of Surgery, Hôpital Beaujon, Paris, France.

Address reprint requests to Jean-Nicolas Vauthey, MD, Department of Surgical Oncology, Box 444, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; email: jvauthey{at}mdanderson.org

PURPOSE: The current American Joint Committee on Cancer (AJCC) staging system for hepatocellular carcinoma (HCC) fails to stratify patients adequately with respect to prognosis.

PATIENTS AND METHODS: The ability of the currently proposed tumor (T) categories to effectively stratify the survival of 557 patients who underwent complete resection for HCC at four centers was examined. Independent predictors of survival were combined into a new staging system.

RESULTS: Using the current AJCC T classification, patients with T1 and T2 tumors had similar 5-year survivals (P = .6). In addition, the survival of patients with multiple bilobar tumors (T4) matched that of T3 patients (P = .5). Independent predictors of death were major vascular invasion (P < .001), microvascular invasion (P = .001), severe fibrosis/cirrhosis of the host liver (P = .001), multiple tumors (P = .007), and tumor size greater than 5 cm (P = .01). Based on our results, a simplified stratification is proposed: (a) patients with a single tumor and no microvascular invasion, (b) patients with a single tumor and microvascular invasion or multiple tumors, none more than 5 cm, and (c) patients with either multiple tumors, any more than 5 cm, or tumor with major vascular invasion (P < .001). Severe fibrosis/cirrhosis had a negative impact on survival within all categories. The survival of patients with lymph node involvement matched that of patients with major vascular invasion (P = .3).

CONCLUSION: The current AJCC staging system for HCC is unnecessarily complex. We propose a simplified model of stratification that is based on vascular invasion, tumor number, and tumor size and incorporates the effect of fibrosis on survival.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. Kikuchi, V. Margulis, P. I. Karakiewicz, M. Roscigno, S. Mikami, Y. Lotan, M. Remzi, C. Bolenz, C. Langner, A. Weizer, et al. Lymphovascular Invasion Predicts Clinical Outcomes in Patients With Node-Negative Upper Tract Urothelial Carcinoma J. Clin. Oncol., February 1, 2009; 27(4): 612 - 618. [Abstract] [Full Text] [PDF]

				M. Palavecino, C. Wittekind, and J. N. Vauthey Treatment of Stage IVA Hepatocellular Carcinoma Arch Surg, December 1, 2008; 143(12): 1235 - 1236. [Full Text] [PDF]

				J. M. Llovet, A. M. Di Bisceglie, J. Bruix, B. S. Kramer, R. Lencioni, A. X. Zhu, M. Sherman, M. Schwartz, M. Lotze, J. Talwalkar, et al. Design and Endpoints of Clinical Trials in Hepatocellular Carcinoma J Natl Cancer Inst, May 21, 2008; 100(10): 698 - 711. [Abstract] [Full Text] [PDF]

				R. Tsunedomi, N. Iizuka, T. Tamesa, K. Sakamoto, T. Hamaguchi, H. Somura, M. Yamada, and M. Oka Decreased ID2 Promotes Metastatic Potentials of Hepatocellular Carcinoma by Altering Secretion of Vascular Endothelial Growth Factor Clin. Cancer Res., February 15, 2008; 14(4): 1025 - 1031. [Abstract] [Full Text] [PDF]

				W. Hofstetter, A. M. Correa, N. Bekele, J. A. Ajani, A. Phan, R. R. Komaki, Z. Liao, D. Maru, T. T. Wu, R. J. Mehran, et al. Proposed Modification of Nodal Status in AJCC Esophageal Cancer Staging System Ann. Thorac. Surg., August 1, 2007; 84(2): 365 - 375. [Abstract] [Full Text] [PDF]

				Y. Yuan, J. Wang, J. Li, L. Wang, M. Li, Z. Yang, C. Zhang, and J. L. Dai Frequent Epigenetic Inactivation of Spleen Tyrosine Kinase Gene in Human Hepatocellular Carcinoma. Clin. Cancer Res., November 15, 2006; 12(22): 6687 - 6695. [Abstract] [Full Text] [PDF]

				W. Yeo, F. K. F. Mo, J. Koh, A. T. C. Chan, T. Leung, P. Hui, L. Chan, A. Tang, J. J. Lee, T. S. K. Mok, et al. Quality of life is predictive of survival in patients with unresectable hepatocellular carcinoma Ann. Onc., July 1, 2006; 17(7): 1083 - 1089. [Abstract] [Full Text] [PDF]

				K. K. Tanabe, L. S. Blaszkowsky, R. T. Chung, M. A. Blake, and G. Y. Lauwers Case 23-2005 - A 57-Year-Old Man with a Mass in the Liver N. Engl. J. Med., July 28, 2005; 353(4): 401 - 410. [Full Text] [PDF]

				T. M. Pawlik, R. T. Poon, E. K. Abdalla, D. Zorzi, I. Ikai, S. A. Curley, D. M. Nagorney, J. Belghiti, I. O.-L. Ng, Y. Yamaoka, et al. Critical Appraisal of the Clinical and Pathologic Predictors of Survival After Resection of Large Hepatocellular Carcinoma Arch Surg, May 1, 2005; 140(5): 450 - 458. [Abstract] [Full Text] [PDF]

				J. Goodman, S. C. Glasgow, M. Schnitzler, J. A. Lowell, S. Shenoy, M. D. Jendrisak, N. Desai, M. Lisker-Melman, J. Crippin, and W. C. Chapman Liver Transplantation for Hepatocellular Carcinoma: Expanding Special Priority to Include Stage III Disease Arch Surg, May 1, 2005; 140(5): 459 - 464. [Abstract] [Full Text] [PDF]

				M. Kawashima, J. Furuse, T. Nishio, M. Konishi, H. Ishii, T. Kinoshita, M. Nagase, K. Nihei, and T. Ogino Phase II Study of Radiotherapy Employing Proton Beam for Hepatocellular Carcinoma J. Clin. Oncol., March 20, 2005; 23(9): 1839 - 1846. [Abstract] [Full Text] [PDF]

				S. T. Cheung, K. L. Leung, Y. C. Ip, X. Chen, D. Y. Fong, I. O. Ng, S. T. Fan, and S. So Claudin-10 Expression Level is Associated with Recurrence of Primary Hepatocellular Carcinoma Clin. Cancer Res., January 15, 2005; 11(2): 551 - 556. [Abstract] [Full Text] [PDF]

				C. Valls, M. Cos, J. Figueras, E. Andia, E. Ramos, A. Sanchez, T. Serrano, and J. Torras Pretransplantation Diagnosis and Staging of Hepatocellular Carcinoma in Patients with Cirrhosis: Value of Dual-Phase Helical CT Am. J. Roentgenol., April 1, 2004; 182(4): 1011 - 1017. [Abstract] [Full Text] [PDF]

				J.-N. Vauthey and J. A. Ajani Liver Transplantation and Hepatocellular Carcinoma Biology: Beginning of the End of the Era of Educated Guesses J. Clin. Oncol., December 1, 2003; 21(23): 4265 - 4267. [Full Text] [PDF]