Prognosis Evaluation in Patients with Hepatocellular Carcinoma after Hepatectomy: Comparison of BCLC, TNM and Hangzhou Criteria Staging Systems

Purpose: This study is to evaluate the Hangzhou criteria (HC) for patients with HCC undergoing surgical resection and to identify whether this staging system is superior to other staging systems in predicting the survival of resectable HCC. Method: 774 HCC patients underwent surgical resection between 2007 and 2009 in West China Hospital were enrolled retrospectively. Predictors of survival were identified using the Kaplan-Meier method and the Cox model. The disease state was staged by the HC, as well as by the TNM and BCLC staging systems. Prognostic powers were quantified using a linear trend chi 2 test, c-index, and the likelihood ratio (LHR) chi 2 test and correlated using Cox's regression model adjusted using the Akaike information criterion (AIC). Results: Serum AFP level (P = 0.02), tumor size (P < 0.001), tumor number (P < 0.001), portal vein invasion (P < 0.001), hepatic vein invasion (P < 0.001), tumor differentiation (P < 0.001), and distant organ (P = 0.016) and lymph node metastasis (P < 0.001) were identified as independent risk factors of survival after resection by multivariate analysis. The comparison of the different staging system results showed that BCLC had the best homogeneity (likelihood ratio chi(2) test 151.119, P < 0.001), the TNM system had the best monotonicity of gradients (linear trend chi(2) test 137.523, P < 0.001), and discriminatory ability was the highest for the BCLC (the AUCs for 1-year mortality were 0.759) and TNM staging systems (the AUCs for 3-, and 5-year mortality were 0.738 and 0.731, respectively). However, based on the c-index and AIC, the HC was the most informative staging system in predicting survival (c-index 0.6866, AIC 5924.4729). Conclusions: The HC can provide important prognostic information after surgery. The HC were shown to be a promising survival predictor in a Chinese cohort of patients with resectable HCC.