Proposal For A Subgroup Scoring System Of Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma Patients Based On Multivariate Analysis To Facilitate Treatment Decisions

Objective: Lots of examples in clinical demonstrate that the heterogeneity of BCLC-C stage liver cancer patients infects prognosis and facilitation decisions of treatment.The objectives of our study are(1)to identify risk factors which may affect prognosis of BCLC-C stage liver cancer patients,(2)to establish a new subgroup scoring system of advanced liver cancer based on multivariate analysis,(3)to identify discriminatory ability of the new subgroup scoring system for selecting treatment,(4)to compare clinical effect of traditional Chinese medicine treatment,TACE treatment and BST treatment for BCLC-C stage liver cancer patients in relation to subgroup scoring system.Methods From 2012 to 2014,282 cases of patients from Changhai hospital,Shanghai Traditional Chinese Medicine Hospital,Jiangxi Tumor Hospital and the Fifth Affiliated Hospital of Nanchang University,who were diagnosed with BCLC-C stage liver cancer were recruited in this retrospective clinical study.Univariate and multivariate analyses were used to identify risk factors which might infect prognosis of those advanced liver cancer patients.Survival and hazard function curves were plotted with Kaplan-Meier method and median survival time were compared with a log-rank test.The COX regression model was used to select independent risk factors which shown significant difference in univariate analysis.Then we established a new subgroup scoring system of BCLC-C liver cancer using the weight summed method based on the independent risk factors.We divided these advanced liver cancer patients into three subgroups: BCLC-C1 group,BCLC-C2 group and BCLC-C3 group.The medial survival time and long-term survival rate of each subgroup were calculated.By comparing the medial survival time of the same subgroups in different treatments to find out the most suitable treatment for advanced liver cancer patients.The results were confirmed by subsequent validation group of 90 cases.Results Five variable were selected as independent risk factors affecting BCLC-C stage liver cancer through COX regression model: Child-Pugh grade,AFP,lymphatic metastasis,vascular invasion and extra-hepatic spread.Their weight are Child-Pugh grade 1,AFP 1,lymphatic metastasis 1,vascular invasion 1,extra-hepatic spread 1 respectively.The new subgroup scoring system model was finally established like this: Child-Pugh grade(A grade=0 B grade=1),AFP(<400ng/nl=0,≥400ng/nl=1),lymphatic metastasis(absent=0 present=1),vascular invasion(absent=0 present=1),extra-hepatic spread(absent=0 present=1).There are three subgroups in the new scoring system: 1~2 for BCLC-C1 group,3 for BCLC-C2,4~5 for BCLC-C3 group.The new scoring system can successfully divide the patients into three subgroups in TCM group,TACE group and BST group respectively.As result,there are significant differences among subgroups,and the prognosis of patients is dependent on the new defined subgroups.For BCLC-C1 subgroup,the median survival time was 10.7 months,10.3 months,4.6 months for patients who received TCM treatment,TACE treatment and BST treatment respectively.The medial survival time of TCM group was significantly longer than TACE and BST group(P<0.05).TACE group was superior to BST group in survival(P<0.05).For BCLC-C2 subgroup,the median survival time was 5.7 months,5 months,5.1 months for patients who received TCM treatment,TACE treatment and BST treatment respectively.The medial survival time of TCM group was also significantly longer than TACE and BST group(P<0.05).But there’s no significant difference between TACE group and BST group(P>0.05).For BCLC-C3 subgroup,the median survival time was 1 month,2 months,1.6 months for patients who received TCM treatment,TACE treatment and BST treatment respectively.There’s no significant difference among TCM group,TACE group and BST group(P>0.05).Conclusions(1)The medial survival time of TCM group was significantly longer than TACE and BST group(P<0.05).(2)The patients were divided into three subgroups: BCLC-C1,BCLC-C2 and BCLC-C3.The medial survival time of BCLC-C1 subgroup was longer than BCLC-C2 and BCLC-C3 subgroups(P<0.05).(3)The medial survival time of BCLC-C1,BCLC-C2 subgroups in TCM group were longer than that of in TACE group and BST group(P<0.05).In BCLC-C2 subgroups,there’s no significant difference between TACE group and BST group(P>0.05).In BCLC-C3 subgroups,there’s no significant difference among TCM group,TACE group and BST group(P>0.05).(4)It’s hard to predict life expectancy of BCLC-C stage liver cancer patients because of the heterogeneity of advanced liver cancer.Child-Pugh grade,AFP,lymphatic metastasis,vascular invasion and extra-hepatic metastasis were independent risk factors for medial survival time of advanced liver cancer.The new subgroup scoring system of BCLC-C stage hepatocellular carcinoma patients based on these factors can not only precisely predict the prognosis of advanced liver cancer,but also guide the clinician to select the best and most beneficial treatment for each advanced HCC patient.