Semin Liver Dis 2005; 25(2): 171-180
DOI: 10.1055/s-2005-871197
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Prognostic Prediction in Patients with Hepatocellular Carcinoma

Margarita Sala1 , Alejandro Forner1 , Maria Varela1 , Jordi Bruix1 , 2
  • 1Liver Unit, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
  • 2Senior Consultant and Associate Professor of Medicine
Further Information

Publication History

Publication Date:
25 May 2005 (online)

ABSTRACT

With most solid tumors, the estimation of life expectancy is related to tumor stage at diagnosis and staging is directly linked to treatment indication. By contrast, in patients with hepatocellular carcinoma (HCC) the prediction of prognosis is more complex. There is no worldwide consensus on the use of any HCC staging system. Classifications that take into account only one of the relevant prognostic parameters, such as tumor, nodes, and metastasis (TNM) or Child-Pugh staging, are useless. Several scoring systems have been developed, but unfortunately their major capacity is to identify end-stage patients and they do not link staging with therapy. The Barcelona Clinic Liver Cancer (BCLC) staging system was developed according to the results of cohort studies and randomized clinical trials. It considers tumor stage, liver functional status, physical status, and cancer-related symptoms and, by dividing patients into early, intermediate, advanced, and end-stage categories, provides a link to treatment indication.

REFERENCES

  • 1 Bruix J, Sherman M, Llovet J M et al.. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference.  J Hepatol. 2001;  35 421-430
  • 2 Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors.  Gastroenterology. 2004;  127(5 suppl 1) S35-S50
  • 3 American Joint Committee on Cancer. AJCC Cancer Staging Handbook. New York; Springer 2002
  • 4 Pugh R N, Murray-Lyon I M, Dawson J L et al.. Transection of the oesophagus for bleeding oesophageal varices.  Br J Surg. 1973;  60 646-649
  • 5 Kamath P S, Wiesner R H, Malinchoc M et al.. A model to predict survival in patients with end-stage liver disease.  Hepatology. 2001;  33 464-470
  • 6 Sorensen J B, Klee M, Palshof T, Hansen H H. Performance status assessment in cancer patients. An inter-observer variability study.  Br J Cancer. 1993;  67 773-775
  • 7 Schag C C, Heinrich R L, Ganz P A. Karnofsky performance status revisited: reliability, validity, and guidelines.  J Clin Oncol. 1984;  2 187-193
  • 8 Primack A, Vogel C L, Kyalwazi S K et al.. A staging system for hepatocellular carcinoma: prognostic factors in Ugandan patients.  Cancer. 1975;  35 1357-1364
  • 9 Chlebowski R T, Tong M, Weissman J et al.. Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients.  Cancer. 1984;  53 2701-2706
  • 10 Attali P, Prod'Homme S, Pelletier G et al.. Prognostic factors in patients with hepatocellular carcinoma. Attempts for the selection of patients with prolonged survival.  Cancer. 1987;  59 2108-2111
  • 11 Falkson G, Cnaan A, Schutt A J et al.. Prognostic factors for survival in hepatocellular carcinoma.  Cancer Res. 1988;  48 7314-7318
  • 12 Calvet X, Bruix J, Gines P et al.. Prognostic factors of hepatocellular carcinoma in the west: a multivariate analysis in 206 patients.  Hepatology. 1990;  12 753-760
  • 13 Stuart K E, Anand A J, Jenkins R L. Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival.  Cancer. 1996;  77 2217-2222
  • 14 A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. The Cancer of the Liver Italian Program (CLIP) investigators.  Hepatology. 1998;  28 751-755
  • 15 Llovet J M, Bustamante J, Castells A et al.. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials.  Hepatology. 1999;  29 62-67
  • 16 Villa E, Moles A, Ferretti I et al.. Natural history of inoperable hepatocellular carcinoma: estrogen receptors' status in the tumor is the strongest prognostic factor for survival.  Hepatology. 2000;  32 233-238
  • 17 Llovet J M, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification.  Semin Liver Dis. 1999;  19 329-338
  • 18 Chevret S, Trinchet J C, Mathieu D et al.. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire.  J Hepatol. 1999;  31 133-141
  • 19 Leung T W, Tang A M, Zee B et al.. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients.  Cancer. 2002;  94 1760-1769
  • 20 Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score).  J Gastroenterol. 2003;  38 207-215
  • 21 Omagari K, Honda S, Kadokawa Y et al.. Preliminary analysis of a newly proposed prognostic scoring system (SLiDe score) for hepatocellular carcinoma.  J Gastroenterol Hepatol. 2004;  19 805-811
  • 22 Tateishi R, Yoshida H, Shiina S et al.. Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients.  Gut. 2005;  54 419-425
  • 23 Altman D G, Royston P. What do we mean by validating a prognostic model?.  Stat Med. 2000;  19 453-473
  • 24 Okuda K, Ohtsuki T, Obata H et al.. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients.  Cancer. 1985;  56 918-928
  • 25 Schoniger-Hekele M, Muller C, Kutilek M et al.. Hepatocellular carcinoma in Central Europe: prognostic features and survival.  Gut. 2001;  48 103-109
  • 26 Herold C, Reck T, Fischler P et al.. Prognosis of a large cohort of patients with hepatocellular carcinoma in a single European centre.  Liver. 2002;  22 23-28
  • 27 Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. The Cancer of the Liver Italian Program (CLIP) investigators.  Hepatology. 2000;  31 840-845
  • 28 Farinati F, Rinaldi M, Gianni S, Naccarato R. How should patients with hepatocellular carcinoma be staged? Validation of a new prognostic system.  Cancer. 2000;  89 2266-2273
  • 29 Ueno S, Tanabe G, Sako K et al.. Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program.  Hepatology. 2001;  34 529-534
  • 30 Levy I, Sherman M. Staging of hepatocellular carcinoma: assessment of the CLIP, Okuda, and Child-Pugh staging systems in a cohort of 257 patients in Toronto.  Gut. 2002;  50 881-885
  • 31 Kudo M, Chung H, Haji S et al.. Validation of a new prognostic staging system for hepatocellular carcinoma: the JIS score compared with the CLIP score.  Hepatology. 2004;  40 1396-1405
  • 32 Grieco A, Pompili M, Caminiti G et al.. Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre.  Gut. 2005;  54 411-418
  • 33 Marrero J, Fontana R, Barrat A et al.. Prognosis of hepatocellular carcinoma: comparison of seven staging systems in an American cohort.  Hepatology. 2005;  41 707-716
  • 34 Llovet J M, Burroughs A, Bruix J. Hepatocellular carcinoma.  Lancet. 2003;  362 1907-1917
  • 35 Cillo U, Bassanello M, Vitale A et al.. The critical issue of hepatocellular carcinoma prognostic classification: which is the best tool available?.  J Hepatol. 2004;  40 124-131
  • 36 Barbara L, Benzi G, Gaiani S et al.. Natural history of small untreated hepatocellular carcinoma in cirrhosis: a multivariate analysis of prognostic factors of tumor growth rate and patient survival.  Hepatology. 1992;  16 132-137
  • 37 Livraghi T, Bolondi L, Buscarini L et al.. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group.  J Hepatol. 1995;  22 522-526
  • 38 Ebara M, Ohto M, Shinagawa T et al.. Natural history of minute hepatocellular carcinoma smaller than three centimeters complicating cirrhosis. A study in 22 patients.  Gastroenterology. 1986;  90 289-298
  • 39 Bruix J, Llovet J M, Castells A et al.. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution.  Hepatology. 1998;  27 1578-1583
  • 40 Castells A, Bruix J, Bru C et al.. Treatment of hepatocellular carcinoma with tamoxifen: a double-blind placebo-controlled trial in 120 patients.  Gastroenterology. 1995;  109 917-922
  • 41 Llovet J M, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation.  Hepatology. 1999;  30 1434-1440
  • 42 Wayne J D, Lauwers G Y, Ikai I et al.. Preoperative predictors of survival after resection of small hepatocellular carcinomas.  Ann Surg. 2002;  235 722-730
  • 43 Vauthey J N, Lauwers G Y, Esnaola N F et al.. Simplified staging for hepatocellular carcinoma.  J Clin Oncol. 2002;  20 1527-1536
  • 44 Ikai I, Arii S, Kojiro M et al.. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey.  Cancer. 2004;  101 796-802
  • 45 Torzilli G, Makuuchi M, Inoue K et al.. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach.  Arch Surg. 1999;  134 984-992
  • 46 Bruix J, Castells A, Bosch J et al.. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure.  Gastroenterology. 1996;  111 1018-1022
  • 47 Poon R T, Fan S T, Ng I O et al.. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma.  Cancer. 2000;  89 500-507
  • 48 Imamura H, Matsuyama Y, Tanaka E et al.. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy.  J Hepatol. 2003;  38 200-207
  • 49 Mazzaferro V, Regalia E, Doci R et al.. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.  N Engl J Med. 1996;  334 693-699
  • 50 Plessier A, Codes L, Consigny Y et al.. Underestimation of the influence of satellite nodules as a risk factor for post-transplantation recurrence in patients with small hepatocellular carcinoma.  Liver Transpl. 2004;  10(suppl 2) S86-S90
  • 51 Sala M, Llovet J M, Vilana R et al.. Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma.  Hepatology. 2004;  40 1352-1360
  • 52 Llovet J M, Real M I, Montanya X et al.. Arterial embolization, chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial.  Lancet. 2002;  359 1734-1739
  • 53 Bruix J, Boix L, Sala M, Llovet J M. Focus on hepatocellular carcinoma.  Cancer Cell. 2004;  5 215-219
  • 54 Takayama T, Makuuchi M, Hirohashi S et al.. Early hepatocellular carcinoma as an entity with a high rate of surgical cure.  Hepatology. 1998;  28 1241-1246

Jordi BruixM.D. 

BCLC Group. Liver Unit, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer

Villarroel 170, 08036 Barcelona, Spain

Email: bruix@ub.edu

    >