Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization

Khairuddin Memon, Laura M. Kulik, Robert J. Lewandowski, Edward Wang, Jonathan Wang, Robert K. Ryu, Ryan Hickey, Michael Vouche, Talia Baker, Daniel Ganger, Vanessa L. Gates, Ali Habib, Mary F. Mulcahy, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose To compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 (90Y) radioembolization. Materials and Methods During the period 2004-2011, 428 patients with HCC were treated with 90Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival. Results When tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34-0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44-0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40-0.89), absence of ascites (HR, 0.56; CI, 0.40-0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55-0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50-0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51-0.86). Conclusions CLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after 90Y radioembolization.

Original languageEnglish (US)
Pages (from-to)1056-1066
Number of pages11
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number7
DOIs
StatePublished - Jan 1 2014

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Hepatocellular Carcinoma
Liver Neoplasms
Confidence Intervals
Survival
Fetal Proteins
Yttrium
Systems Analysis
Proportional Hazards Models
Ascites
Venous Thrombosis
Alkaline Phosphatase
Albumins
Linear Models
Japan
Multivariate Analysis
Clinical Trials
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Memon, Khairuddin ; Kulik, Laura M. ; Lewandowski, Robert J. ; Wang, Edward ; Wang, Jonathan ; Ryu, Robert K. ; Hickey, Ryan ; Vouche, Michael ; Baker, Talia ; Ganger, Daniel ; Gates, Vanessa L. ; Habib, Ali ; Mulcahy, Mary F. ; Salem, Riad. / Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization. In: Journal of Vascular and Interventional Radiology. 2014 ; Vol. 25, No. 7. pp. 1056-1066.
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abstract = "Purpose To compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 (90Y) radioembolization. Materials and Methods During the period 2004-2011, 428 patients with HCC were treated with 90Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival. Results When tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34-0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44-0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40-0.89), absence of ascites (HR, 0.56; CI, 0.40-0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55-0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50-0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51-0.86). Conclusions CLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after 90Y radioembolization.",
author = "Khairuddin Memon and Kulik, {Laura M.} and Lewandowski, {Robert J.} and Edward Wang and Jonathan Wang and Ryu, {Robert K.} and Ryan Hickey and Michael Vouche and Talia Baker and Daniel Ganger and Gates, {Vanessa L.} and Ali Habib and Mulcahy, {Mary F.} and Riad Salem",
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Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization. / Memon, Khairuddin; Kulik, Laura M.; Lewandowski, Robert J.; Wang, Edward; Wang, Jonathan; Ryu, Robert K.; Hickey, Ryan; Vouche, Michael; Baker, Talia; Ganger, Daniel; Gates, Vanessa L.; Habib, Ali; Mulcahy, Mary F.; Salem, Riad.

In: Journal of Vascular and Interventional Radiology, Vol. 25, No. 7, 01.01.2014, p. 1056-1066.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization

AU - Memon, Khairuddin

AU - Kulik, Laura M.

AU - Lewandowski, Robert J.

AU - Wang, Edward

AU - Wang, Jonathan

AU - Ryu, Robert K.

AU - Hickey, Ryan

AU - Vouche, Michael

AU - Baker, Talia

AU - Ganger, Daniel

AU - Gates, Vanessa L.

AU - Habib, Ali

AU - Mulcahy, Mary F.

AU - Salem, Riad

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose To compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 (90Y) radioembolization. Materials and Methods During the period 2004-2011, 428 patients with HCC were treated with 90Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival. Results When tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34-0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44-0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40-0.89), absence of ascites (HR, 0.56; CI, 0.40-0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55-0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50-0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51-0.86). Conclusions CLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after 90Y radioembolization.

AB - Purpose To compare the utility of different staging systems and analyze independent predictors of survival in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 (90Y) radioembolization. Materials and Methods During the period 2004-2011, 428 patients with HCC were treated with 90Y radioembolization. All patients were staged prospectively by the following staging systems: Child-Turcotte-Pugh (CTP), United Network for Organ Sharing, Barcelona Clinic Liver Cancer (BCLC), Okuda classification, Cancer of the Liver Italian Program (CLIP), Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, Chinese University Prognostic Index, and Japan Integrated Staging. The ability of the staging systems to predict survival was assessed. The staging systems were compared using Cox proportional hazards regression model, linear regression, Akaike information criterion (AIC), and concordance index (C-index). Univariate and multivariate analyses were employed to assess independent predictors of survival. Results When tested independently, all staging systems exhibited significant ability to discriminate early (long survival) from advanced (worse survival) disease. CLIP provided the most accurate information in predicting survival outcomes (AIC = 2,993, C-index = 0.8503); CTP was least informative (AIC = 3,074, C-index = 0.6445). Independent predictors of survival included Eastern Cooperative Oncology Group performance status grade 0 (hazard ration [HR], 0.56; confidence interval [CI], 0.34-0.93), noninfiltrative tumors (HR, 0.62; CI, 0.44-0.89), absence of portal venous thrombosis (HR, 0.60; CI, 0.40-0.89), absence of ascites (HR, 0.56; CI, 0.40-0.76), albumin ≥ 2.8 g/dL (HR, 0.72; CI, 0.55-0.94), alkaline phosphatase ≤ 200 U/L (HR, 0.68; CI, 0.50-0.92), and α-fetoprotein ≤ 200 ng/mL (HR, 0.67; CI, 0.51-0.86). Conclusions CLIP was most accurate in predicting survival in patients with HCC. Given that not all patients receive the recommended BCLC treatment strategy, this information is relevant for clinical trial design and predicting long-term outcomes after 90Y radioembolization.

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