Is the Hong Kong Liver Cancer staging system the best guide for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors?
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Shuang Liu1,*, Xiaoqiang Li1,*, Hui Li1,*, Lei Guo1, Bo Zhang1, Jubo Zhang1, Qinghai Ye1
1Liver Cancer Institute and Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Ministry of Education, Shanghai, China
*These authors have contributed equally to this work
Qinghai Ye, email: [email protected]
Keywords: hepatocellular carcinoma, multiple tumors, Hong Kong Liver Cancer staging system, radical resection, overall survival
Received: March 23, 2016 Accepted: May 26, 2016 Published: June 13, 2016
It still must be confirmed whether the newly developed Hong Kong Liver Cancer Staging (HKLC) system can effectively stratify patients with multiple tumors and identify patients who could obtain a survival benefit with radical resection. In this study, we retrospectively compared survival rates of surgery versus transcatheter arterial chemoembolization for hepatitis B virus-related hepatocellular carcinoma patients with multiple tumors by using the propensity score method. In addition, the prognostic roles of tumor size, number and thrombus status together with other covariates on postoperative survival were analyzed by multivariate analysis. In matched cohorts, surgical treatment could significantly reduce patient mortality in patients within or outside HKLC criteria (odds ratio (OR) = 0.5, P < 0.001, OR = 0.6, P = 0.001, respectively). In 941 patients undergoing radical resection, the state of tumor thrombus demonstrated a significant interaction with tumor size on postoperative survival (P for interaction = 0.041). Tumor number was not a predictor of postoperative survival in patients with multiple tumors (adjusted OR = 1.1, P = 0.202). In patients without tumor thrombus, tumor size > 5 cm was an independent risk factor of postoperative survival (OR = 1.7, P < 0.001). In patients without tumor thrombus, patient survival was mainly influenced by tumor location (OR = 2.1, P < 0.001). In summary, patients with multiple tumors could obtain a survival benefit from radical surgery based on the more aggressive HKLC staging system. However, parameters in this staging system still need further adjustments.
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