Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2020; 12(12): 1239-1257
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1239
Comparison between hepatocellular carcinoma prognostic scores: A 10-year single-center experience and brief review of the current literature
Michele Campigotto, Mauro Giuffrè, Anna Colombo, Alessia Visintin, Alessandro Aversano, Martina Budel, Flora Masutti, Cristiana Abazia, Lory Saveria Crocé
Michele Campigotto, Mauro Giuffrè, Anna Colombo, Alessia Visintin, Alessandro Aversano, Martina Budel, Lory Saveria Crocé, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e Della Salute, Università degli Studi di Trieste, Trieste 34149, Italy
Flora Masutti, Cristiana Abazia, Lory Saveria Crocé, Clinica Patologie del Fegato, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste 34149, Italy
Author contributions: Campigotto M, Giuffrè M and Crocé LS conceived the study and drafted the manuscript; Colombo A, Visintin A, Aversano A, Budel M, Masutti F, and Colombo A collected the data; All authors reviewed the final version of the manuscript.
Institutional review board statement: The study was conducted retrospectively, without performing any intervention on patients.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: All data requests should be submitted to the corresponding author for consideration. Access to anonymized data may be granted following review.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mauro Giuffrè, MD, MSc, Academic Fellow, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e Della Salute, Università degli Studi di Trieste, No. 447 Strada di Fiume, Trieste 34149, Italy. gff.mauro@gmail.com
Received: June 30, 2020
Peer-review started: June 30, 2020
First decision: August 9, 2020
Revised: August 14, 2020
Accepted: October 9, 2020
Article in press: October 9, 2020
Published online: December 27, 2020
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) represents the most common primitive liver malignancy. A relevant concern involves the lack of agreement on staging systems, prognostic scores, and treatment allocation algorithms. 

AIM

To compare the survival rates among already developed prognostic scores.

METHODS

We retrospectively evaluated 140 patients with HCC diagnosed between February 2006 and November 2017. Patients were categorized according to 15 prognostic scoring systems and estimated median survivals were compared with those available from the current medical literature.

RESULTS

The median overall survival of the cohort of patients was 35 (17; 67) mo, and it was statistically different in relation to treatment choice, ultrasound surveillance, and serum alpha-fetoprotein. The Italian Liver Cancer (ITA.LI.CA) tumor staging system performed best in predicting survival according to stage allocation among all 15 evaluated prognostic scores. Using the ITA.LI.CA prognostic system, 28.6%, 40.7%, 22.1%, and 8.6% of patients fell within stages 0-1, 2-3, 4-5 and > 5 respectively. The median survival was 57.9 mo for stages 0-1, 43 mo for stages 2-3, 21.7 mo for stages 4-5, and 10.4 mo for stage > 5. The 1-, 3-, and 5-year survival rates were respectively 95%, 65%, and 20%, for stages 0-1; 94.7%, 43.9% and 26.3% for stages 2-3; 71%, 25.8% and 16.1% for stages 4-5; and 50%, 16.7% and 8.3% for stage > 5. At the same time, although statistically significant in prognostic stratification, the most commonly used Barcelona Clinic Liver Cancer system showed one of the most relevant differences in median survival, especially for stages A and C, when compared to the medical literature. In fact, 10.7%, 59.3%, 27.1%, 1.4%, and 0% of patients were stratified into stages 0, A, B, C, and D respectively. The median survival was > 81.1 mo for stage 0, 44.9 mo for stage A, 21.3 mo for stage B, and 3.1 mo for stage C. The 1-, 3-, and 5-year survival rates were respectively 86.7%, 60%, and 46.7% for stage 0; 91.6%, 50.6%, and 20.5% for stage A; 73.7%, 23.7% and 13.2% for stage B; and 2%, 0% and 0% for stage C.

CONCLUSION

Survival analysis shows excellent prognostic ability of the ITA.LI.CA scoring system compared to other staging systems.

Keywords: Hepatocellular carcinoma, Prognostic score system, Prognostic factors, Survival analysis, Barcelona Clinic Liver Cancer score system, Italian Liver Cancer score system

Core Tip: Italian Liver Cancer tumor staging system seems a promising prognostic score system with a good applicability and reproducibility for patients with hepatocellular carcinoma.