Year: 2016
Type: article
Abstract: Hepatocellular carcinoma (HCC) is an increasingly common and highly morbid malignancy.Appropriate tumor staging is crucial to inform prognosis and guide treatment decisions in clinical practice; however, staging for HCC can be complex because of many patient-level factors that can impact prognosis and treatment eligibility.HCC is a unique malignancy in that it typically occurs in the setting of underlying organ dysfunction (i.e., cirrhosis), so most staging systems take both tumor burden and the degree of underlying liver dysfunction into account for prognostication.The most commonly used staging systems for HCC include the Barcelona Clinic Liver Cancer (BCLC) system [1], the Hong Kong Liver Cancer (HKLC) system [2], the Cancer of the Liver Italian Program (CLIP) system [3], the Japan Integrated Staging (JIS) system [4], and the Model to Estimate Survival in Ambulatory HCC patients (MESIAH) (Table 1) [5].However, there has been a lack of consensus regarding the optimal staging system, and none is universally accepted.Most existing systems were derived from single-center data, lack prospective or external validation, and lack granularity in intermediate-and advanced-stage patients.In this issue of PLOS Medicine, Alessandro Vitale and colleagues detail the derivation and validation of a novel staging system for HCC, the ITA.LI.CA system [6].The ITA.LI.CA system attempts to address many deficiencies of prior staging systems and demonstrates better discriminant ability for predicting survival than existing HCC staging systems in both internal and external validation cohorts.The ITA.LI.CA system was derived from a prospective multicenter database of over 5,000 HCC patients from Italy.The majority of patients in the cohort had hepatitis C infection, nearly all (97%) had good performance status, and three-fourths had well-compensated cirrhosis.External validation was performed using data from a Taiwanese cohort of over 2,600 patients, with the primary etiology of liver disease for patients in this cohort being chronic hepatitis B infection.Using a priori variable selection based on prior staging systems and a literature review, the authors derived a model that uses a prognostic score based upon tumor burden (categories of 0, A, B1-3, and C), functional status, Child-Pugh score, and alpha fetoprotein (AFP) concentration (1,000 or >1,000 ng/ml).The model had better discriminant ability than any of the existing staging systems in the training, internal validation, and external validation cohorts (c-statistic values being 0.72, 0.71, and 0.78, respectively).The BCLC staging system is currently the most widely accepted staging system and has been endorsed by the American Association for the Study of Liver Disease (AASLD) and European Association for the Study of the Liver (EASL) [7,8].Though some aspects of the ITA.LI.CA system are rooted in the BCLC, it is distinct in several important ways: first, in
Source: PLoS Medicine
Authors: Neehar D. Parikh, Amit G. Singal
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,460
OpenAlex ID: W2342983997