A New Prognostic Staging System for Hepatocellular Carcinoma: Value of the Biomarker Combined Japan Integrated Staging Score

Kitai, Satoshi; Kudo, Masatoshi; Minami, Yasunori; Ueshima, Kazuomi; Chung, Hobyung; Hagiwara, Satoru; Inoue, Takamitsu; Ishikawa, Emi; Takahashi, Shunsuke; Asakuma, Yutaka; Haji, Seiji; Osaki, Yukio; Oka, Hiroko; Seki, Toshihito; Kasugai, Hiroshi; Sasaki, Yo; Matsunaga, Takashi

doi:10.1159/000122599

Cited by 40 publications

(34 citation statements)

References 63 publications

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“…The BALAD score is reportedly advantageous since it does not require a tumor-spreading stage. The second method is the biology marker-combined JIS score [33], which is a combination of the original JIS score and 3 tumor markers (AFP, PIVKA-II, AFP-L3). This staging system seems to be superior to the original JIS score and BALAD score [34].…”

Section: Advances Of Integrated Staging Systemmentioning

confidence: 99%

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Kudo

2008

Oncology

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Hepatocellular carcinoma (HCC) is a malignant tumor which is becoming more prevalent worldwide. Patients at high risk of developing HCC, namely hepatitis B- and C-related liver cirrhosis patients, should be entered into surveillance programs, which should be performed using both ultrasonography and 3 tumor markers (AFP, PIVKA-II, AFP-L3). The surveillance interval needs to be shortened for patients at higher risk of HCC. Therefore, super-high-risk patients should be screened at 3- to 4-month intervals based on their risk of developing HCC. Sonazoid-enhanced US is extremely useful to characterize hepatic tumors when compared with multidetector-row computed tomography (MDCT). Moreover, Sonazoid-enhanced US with defect reperfusion imaging is a breakthrough approach in the treatment of HCC. This technique will markedly change the therapeutic strategy for liver cancer. Furthermore, diagnostic capability using the new imaging technique Gd-EOB-DTPA MRI is promising. A reduced uptake (low intensity) in the hepatobiliary phase of Gd-EOB-DTPA MRI strongly suggests HCC (including early-stage HCC) or a high-grade dysplastic nodule with high malignant potential. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective for advanced HCC with vascular invasion; however, no randomized study exists to prove its efficacy. Further controlled study is necessary to establish this treatment option as a standard of care in a treatment algorithm for HCC. In contrast, sorafenib was established as the first choice of treatment as a standard of care in advanced HCC patients with preserved liver function and vascular invasion/extrahepatic spread. Furthermore, global clinical trials are now ongoing using sorafenib as an adjuvant setting after resection, ablation or TACE. Efficacy of combined use of sorafenib with TACE or intra-arterial infusion chemotherapy is not clear. In order to clarify this issue a randomized clinical trial for intermediate and advanced HCC comparing sorafenib alone versus sorafenib combined with maintenance TACE/intra-arterial infusion chemotherapy and/or intra-arterial infusion chemotherapy is scheduled to be initiated in Japan in 2009. If positive results are obtained by these trials, its impact on treatment strategy for HCC will be drastically changed.

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Section: Advances Of Integrated Staging Systemmentioning

confidence: 99%

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Kudo

2008

Oncology

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“…Currently, there are two modified JIS system: biomarker combined JIS system and the model for end stage liver disease-based JIS system (18,19). In the present study, on the basis of above, we herein propose a PS combined JIS (PS-JIS) system for HCC patients with LC.…”

Section: Introductionmentioning

confidence: 97%

Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis

Nishikawa

Kita

Kimura

et al. 2015

International Journal of Oncology

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Abstract. The present study examined the prognostic ability of our proposed performance status combined Japan Integrated Staging (PS-JIS) system in hepatocellular carcinoma (HCC) patients with liver cirrhosis (LC) comparing with other four prognostic systems including original JIS system, the Barcelona Clinic Liver Cancer classification system, TNM classification system and the Cancer of the Liver Italian Program (CLIP) scoring system. A total of 1,170 HCC patients complicated with LC were analysed. The disease was staged for all analysed patients by means of the five staging systems. The cumulative overall survival (OS) rate was calculated by Kaplan-Meier method and tested by log-rank test. We also examined prognostic factors associated with OS using univariate and multivariate analyses and compared the prognostic ability in each prognostic system using concordance index (c-index) at 1-, 3-and 5-year time-points. Overall significance in each prognostic system was P<0.001. In the multivariate analyses, tumor number, Child-Pugh classification, PS, initial treatment modality and several laboratory parameters were significant independent predictors linked to OS. For all cases, in each time-point, the c-index of PS-JIS system was the highest among five staging systems (0.847, 0.816 and 0.808, respectively), indicating that PS-JIS system has the best predictability among these staging systems. According to subgroup analyses stratified by initial treatment modality, in patients treated with surgical resection (n=205), CLIP scoring system had the highest c-index at every timepoint, whereas in patients treated with percutaneous ablative therapies (n=632) at 3-and 5-year time-point and in those with transcatheter arterial therapies (n=281) at every time-point, the c-index of PS-JIS system was the highest. In conclusion, the proposed PS-JIS score can be a useful prognostic system for HCC patients complicated with liver cirrhosis. IntroductionClinical staging for malignancies provides a useful guidance for predicting survival and for deciding optimal treatment strategies (1). Design of a cancer staging system depends on the identification of individual prognostic factors that can predict survival of cancer patients (1-3). Unlike other solid tumors, the prognosis and treatment strategies for subjects with hepatocellular carcinoma (HCC) depend not only on the tumor characteristics but also on the degree of liver function (2-9). Based on the identification of relevant predictors for both the tumor burden and liver functional reserve, several staging systems for HCC including both aspects had been proposed.In 1998, the Cancer of the Liver Italian Program (CLIP) proposed a new scoring system (CLIP scoring system) that accounts for both tumor characteristics and liver function relevant to prognostic evaluation for HCC patients. This score consisted of four variables of Child-Pugh classification, α-fetoprotein (AFP) value, tumor morphology and portal vein invasion and its prognostic ability has been validated in several countries...

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“…Это связано с ранним скринингом ГЦР в Япо-нии и приоритетом хирургического лечения. В 2008 году комбинация баллов по JIS с данными трех маркеров ГЦР в крови (AFP, AFP-L3 и дез-гамма-карбокси протромбин) стала использоваться в качестве биомаркера [22]. Однако в западных странах, где ГЦР часто диагностируется на более запущенных и продвинутых стадиях, JIS и ее модификации не используются.…”

Section: обзор исторического развития шкал и классификаций при гцкunclassified

The problem of current classications of the hepatocellular carcinoma. Analytical review

Ротин¹,

Мороз²

2017

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A New Prognostic Staging System for Hepatocellular Carcinoma: Value of the Biomarker Combined Japan Integrated Staging Score

Cited by 40 publications

References 63 publications

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Proposal of the performance status combined Japan Integrated Staging system in hepatocellular carcinoma complicated with cirrhosis

The problem of current classications of the hepatocellular carcinoma. Analytical review

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