International validation of the Chinese University Prognostic Index for staging of hepatocellular carcinoma: a joint United Kingdom and Hong Kong study

Abstract

The outcome of hepatocellular carcinoma (HCC) patients significantly differs between western and eastern population centers. Our group previously developed and validated the Chinese University Prognostic Index (CUPI) for the prognostication of HCC among the Asian HCC patient population. In the current study, we aimed to validate the CUPI using an international cohort of patients with HCC and to compare the CUPI to two widely used staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification and the Cancer of the Liver Italian Program (CLIP). To accomplish this goal, two cohorts of patients were enrolled in the United Kingdom (UK; n = 567; 2006-2011) and Hong Kong (HK; n = 517; 2007-2012). The baseline clinical data were recorded. The performances of the CUPI, BCLC, and CLIP were compared in terms of a concordance index (C-index) and were evaluated in subgroups of patients according to treatment intent. The results revealed that the median follow-up durations of the UK and HK cohorts were 27.9 and 29.8 months, respectively. The median overall survival of the UK and HK cohorts were 22.9 and 8.6 months, respectively. The CUPI stratified the patients in both cohorts into three risk subgroups corresponding to distinct outcomes. The median overall survival of the CUPI low-, intermediate-, and high-risk subgroups were 3.15, 1.24, and 0.29 years, respectively, in the UK cohort and were 2.07, 0.32, and 0.10 years, respectively, in the HK cohort. For the patients who underwent curative treatment, the prognostic performance did not differ between the three staging systems, and all were suboptimal. For those who underwent palliative treatment, the CUPI displayed the highest C-index, indicating that this staging system was the most informative for both cohorts. In conclusion, the CUPI is applicable to both western and eastern HCC patient populations. The performances of the three staging systems differed according to treatment intent, and the CUPI was demonstrated to be optimal for those undergoing palliative treatment. A more precise staging system for early-stage disease patients is required.

Incorporating albumin–bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma

“…Alternatively, the ALBI grade could be readily obtained from the heatmap or normogram without calculation . Patients were then classified according to CP‐CLIP and ALBI‐CLIP (Table ), and other nine staging systems, including 7th edition of American Joint Committee on Cancer Tumor–Node–Metastasis, BCLC, Chinese University Prognostic Index, JIS, Liver Cancer Study Group of Japan TNM, Okuda, and Tokyo systems . Overall survival (OS) was defined as the date of first diagnosis to the time of death, or last follow‐up if death had not occurred.…”

“…In contrast to other malignancies, the prognosis of patients with HCC depends on not only tumor burden but also liver function, performance status, and therapeutic modality. Parameters assessing tumor burden, such as tumor size, number, vascular invasion, extrahepatic spread, or serum alpha‐fetoprotein level, are essential components of all existing HCC staging systems . Factors evaluating liver function, such as ascites, the Child–Pugh (CP) grade, serum albumin, or bilirubin levels, are also included in most of existing staging systems .…”

“…Parameters assessing tumor burden, such as tumor size, number, vascular invasion, extrahepatic spread, or serum alpha‐fetoprotein level, are essential components of all existing HCC staging systems . Factors evaluating liver function, such as ascites, the Child–Pugh (CP) grade, serum albumin, or bilirubin levels, are also included in most of existing staging systems . The CP grade is the conventional approach to assess hepatic dysfunction for patients with chronic liver disease and HCC, and one of the parameters involved in several HCC staging systems .…”

Systematic evaluation of circulating inflammatory markers for hepatocellular carcinoma

“…This study population came from a prospective cohort of patients recruited in the multidisciplinary hepatoma clinic at the Prince of Wales Hospital from January 2009 to December 2012. Part of the cohort has been reported in previous studies . The diagnosis of HCC was made in accordance with the guideline established by the American Association for the Study of Liver disease .…”

“…At the time of consent, both serum and plasma samples were obtained from each subject and archived for future research. The outcome and survival of each patient were followed‐up routinely in the clinic, as described in previous studies . Overall survival was defined from the time of surgery to the time of HCC‐related death, or last follow‐up if death had not occurred.…”