The Prognostic Value Of Different Staging Systems For The Patients Of Barcelona Clinic Liver Cancer Stage C With Transarterial Chemoembolization

Objective:To evaluate the prognostic value of five staging systems(including Okuda staging,Cancer of The Liver Italian Program score,French staging,Chinese Society of Liver Cancer staging and Hong Kong Liver Cancer staging)in the treatment of Barcelona Clinic Liver Cancer stage C patients by transcatheter arterial chemoembolization.It is to explore the best prognostic model for evaluation the Prognosis Value of TACE in patients with Barcelona Clinic Liver Cancer stage C.Methods:We retrospectively studied the patients who were admitted in Interventional and Vascular Surgery Department of Hunan Province People's Hospital between January 2012 to December 2015.According to the inclusion and exclusion criteria,467 cases were collected,all of the patients were Barcelona Clinic Liver Cancer stage C and received TACE treatment.All cases were followed up to December 2016.The survival rate was calculated by Kaplan-Meier method.Log-rank test was used to analyze the survival rate of the single factors.Multivariate COX regression analysis was used to screen out independent risk factors affecting prognosis.Linear trend chi-square test,the likelihood ratio chi-square test,Harrell's concordant c-index were used to assess staging systems for homogeneity,monotonous,discriminant force.The COX proportional hazards model was used to analyze the multivariate analysis of the five staging systems,and the AIC finding the best prognostic model.Results:At the end of follow-up,449 patients were deceased,18 patients were survived.Overall median survival was 8.6 months,with estimated 6 months,1-year and 2-year survival rates as 77.3%,28.1%and 2.8%,respectively.By univariate Kaplan-Meier method analysis,age,history of hepatitis,ascites,Child-Pugh rank,AFP level,tumor number,tumor burden,tumor distribution,the type of portal vein tumor thrombus,tumor response,operation history were significantly correlated with prognosis(P<0.05).But the gender,extrahepatic metastasis were no significantly correlated with prognosis(P>0.05).By Cox multivariate regression analysis,Child-Pugh rank,ascites,AFP level,tumor number,tumor burden,the type of portal vein tumor thrombus and tumor response were independent prognostic factors.Patients with BCLC stage C were retrospected by Okuda staging,CLIP score,French staging,CS staging and HKLC staging,the results showed that different staging were significantly correlated with prognosis(P<0.05).In the five stages,the CLIP score is better than the other stages in monotonous and discriminant force.The weight of the contribution to the pre-value of the AIC value evaluation model found that CLIP score+CS staging model constituted the lowest AIC value,which is the most effective model.And the CLIP score contributed the most to the prognostic model.Conclusion:1.In this retrospective study,the independent prognostic factors affecting the TACE prognosis of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma were Child-Pugh grade,ascites,AFP level,tumor number,tumor burden,the type of portal vein tumor thrombus,and tumor response.2.In this study,the CLIP score had the highest prognostic value.The CS staging added the deficiency of CLIP score on the type of portal vein tumor thrombus.Therefore,the prognostic model of CLIP score+CS staging may be a good prognostic model for evaluating the efficacy of TACE in patients with BCLC stage C in our hospital.