A prognostic index for patients within the intermediate stage of hepatocellular carcinoma

Objective The Barcelona Clinic Liver Cancer algorithm is the most widely used staging system for hepatocellular carcinoma, but the intermediate stage of this classification comprises a very heterogeneous group of patients with different survival probabilities. The aim of our study was to construct a simple prognostic index for identifying subgroups of patients with different prognoses within the intermediate stage. Patients and methods Three-hundred and seven patients were retrospectively analyzed and randomly divided into a training sample (n=205), from which the model was developed, and a test sample (n=102), to independently assess the model's performance. Results Four variables were retained in the final multivariate model: hepatic failure, number of nodules, alpha-fetoprotein, and albumin, with hazard ratios equal to 2.22 (95% confidence interval: 1.52-3.24), 1.47 (1.00-2.18), 2.34 (1.56-3.52), and 1.75 (1.26-2.44), respectively. The score system was derived by summing up the linear weights assigned to the four covariates according to the observed regression coefficients. The score ranged between 4 and 13; to avoid sparse-data bias arising from small numbers within strata, only four categories (4-5, 6-7, 8-9, 10-13) were identified. The prognosis worsened significantly with increasing score and the C-index for discriminatory accuracy was equal to 0.66 (95% confidence interval: 0.60-0.72). The score was validated in the test sample (log-rank test P=0.02). Similar results were found when evaluating the score as a continuous variable. Conclusion The simple prognostic index predicts survival in patients with intermediate-stage hepatocellular carcinoma. This score might help guide treatment selection and patient stratification in clinical studies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.