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document
Prognosis of advanced hepatocellular carcinoma : comparison of three staging systems in two French clinical trials . OBJECTIVE The objective of this study was to assess the performance of three staging systems [ Okuda , Cancer of the Liver Italian Program ( CLIP ) and Barcelona Clinic Liver Cancer group ( BCLC ) ] , for predicting survival in patients with hepatocellular carcinoma ( HCC ) and to explore how to improve prognostic classification among French patients with HCC whose main etiology is alcoholic cirrhosis . METHODS We have pooled two randomized clinical trials in palliative condition from the Fédération Francophone de Cancerologie Digestive . They had included 416 and 122 patients . Performances of Okuda , CLIP and BCLC scores have been compared using Akaike information criterion , discriminatory ability ( Harrell 's C and the Royston 's D statistics ) , monotonicity of gradients and predictive accuracy ( Schemper statistics Vs ) . To explore how to improve classifications , univariate and multivariate Cox model analyses were carried out . RESULTS The pooled database included 538 patients . The median survival was 5.3 months ( 95 % confidence interval 4.6-6.2 ) . For all statistics CLIP staging system had a better prognostic ability . Performances of all staging systems were rather disappointing . World Health Organization performance status ( WHO PS ) for CLIP or alpha-fetoprotein for BCLC allowed a significant improvement of prognostic information . CONCLUSION Our results indicate that CLIP staging seems to be most adapted to palliative setting and that it could be better by associating WHO PS .
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Intervention_Educational
three staging systems [ Okuda , Cancer of the Liver Italian Program ( CLIP ) and Barcelona Clinic Liver Cancer group ( BCLC ) ]
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Outcome_Mortality
survival
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Participant_Condition
advanced hepatocellular carcinoma :
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Participant_Condition
Cancer of the Liver Italian Program ( CLIP )
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Participant_Condition
Barcelona Clinic Liver Cancer group ( BCLC )
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Participant_Condition
patients with hepatocellular carcinoma ( HCC )
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Participant_Condition
We have pooled two randomized clinical trials in palliative condition from the Fédération Francophone de Cancerologie Digestive
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Participant_Sample-size
416 and 122 patients
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Participant_Sample-size
included 538 patients