The Japanese integrated staging score using liver damage grade for hepatocellular carcinoma in patients after hepatectomy
Introduction
Hepatic resection is a good option for radical treatment of hepatocellular carcinoma (HCC)1., 2. and prognosis of patients that undergo such treatment correlates with several tumour-associated factors and liver function.3., 4. The tumour node metastasis (TNM) staging proposed by the Union Internationale Contre le Cancer (International Union against Cancer: UICC)5 and the Liver Cancer Study Group of Japan6 were the useful staging systems of tumour factors. Okamoto has reported the first combined-staging system of both tumour stage and liver function.7 Recently, new combined-staging systems using tumour and liver function factors such as the Cancer of the Liver Italian Program (CLIP),8., 9., 10. Barcelona Clinic Liver Cancer (BCLC),11 Japan integrated staging (JIS) score,12 Chinese University Prognostic Index (CUPI)13 have been proposed and the clinical usefulness of these staging systems for predicting prognosis of patients with HCC were clarified. The JIS score comprising a combination of the Japanese TNM staging and the Child–Pugh classification, which was proposed by the Liver Cancer Study Group of Japan, was the best discriminating staging when compared with TNM staging and CLIP score in 722 Japanese HCC patients.12 The Child–Pugh classification has been commonly used for evaluation in patients with chronic liver diseases.14 This classification may enhance survival of patients with HCC. The liver damage grade proposed by the Liver Cancer Study Group of Japan is also a useful classification for hepatic function6 and those patients with poor liver damage grade compared to the Child–Pugh grade. In HCC patients who undergo hepatic resection, liver function is relatively good and the majority of patients had Child–Pugh A disease. Therefore, it is unclear whether the original JIS score is useful in these patients after hepatectomy.
Patients with poor liver function may die from liver failure, or the severity of liver damage may be associated with the biological behaviour of HCC. We hypothesized that a staging system that uses a reliable classification of hepatic function and tumour stage would provide a better prediction of prognosis of HCC patients than existing systems. In the present study, we conducted a retrospective preliminary analysis of 101 Japanese patients with HCC after hepatic resection at a single Japanese cancer unit. We examined the clinical usefulness of survival as predicted by the JIS system modified using the liver damage grade in these HCC patients, and compared the results with that of the Japanese TNM stage.
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Patients
Data from 101 patients with HCC were collected during surgery on patients who were admitted to the Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences (NUGSBS) and its associated hospitals between January 1990 and January 2003. Patients with remnant tumour after hepatectomy were excluded from this study. The mean age of the patients at the time of surgery was 62.8±9.4 years (range, 28–81 years), and they
Disease-free survival after hepatic resection
In the present study, 61 patients developed tumour recurrence after hepatectomy. Among 101 patients in the study, the disease-free 1-, 3- and 5-year survival rates were 66, 43 and 33%, respectively, and the median disease-free survival period was 3.7 years. Fig. 1(A) shows the disease-free survival curves according to classifications for liver function. Discrimination of the long-term survival in the liver damage grade appeared to perform better than the Child–Pugh classification. Fig. 1(B)
Discussion
The TNM staging of the Liver Cancer Study Group of Japan is useful for determining the spread of HCC,6 and has been commonly used in Japan.15 Recently, Ueno et al.10 reported the clinical usefulness of the CLIP score in a large number of Japanese HCC patients and, therefore, a combined staging system comprising both tumour factors and liver function has been noted in HCC patients since the system reported by Okamoto7 Furthermore, Kudo et al.12 reported that the JIS score combined with the
Acknowledgements
We are grateful to the Digestive System Group of the Second Department of Internal Medicine, Nagasaki University School of Medicine (Prof. Kohno and Dr Omagari), and the Department of Internal Medicine, Nagasaki Municipal Medical Center (Dr Yamasaki) and other associated hospitals for the diagnosis, comments and follow-up of patients with HCC who underwent surgical treatment at our institution.
References (21)
- et al.
Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma
Gastroenterology
(1995) - et al.
Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients
Hepatology
(2001) - et al.
Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection
Gastroenterology
(1994) - et al.
Evaluation of liver function for hepatic resection for hepatocellular carcinoma in the liver with damaged parenchyma
J Surg Res
(2004) - et al.
Hepatocellular carcinoma: diagnosis and treatment
Gastroenterology
(2002) - et al.
Hepatic resection for hepatocellular carcinoma—Japanese experience
Hepatogastroenterology
(1998) - et al.
Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection
Hepatology
(2001) - et al.
Significant influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy. Result of multivariate analysis
Ann Surg
(1996) - et al.
TNM classification of malignant tumours
(2002) - et al.
The general rules for the clinical and pathological study of primary liver cancer (in Japanese)
(2000)
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2014, Journal of Clinical and Experimental HepatologyCitation Excerpt :When choice of ‘curative’ therapies is being debated (eg. local ablation vs. resection vs. transplantation), more detailed anatomical information, as provided in the TNM staging system, as well as more accurate prediction of the risk of HCC recurrence, which is likely to be provided in the near future by biomarkers and molecular classification systems, is needed. Over the years, several systems have been proposed for staging HCC including Okuda staging,3 Pugh's modification of Child–Turcotte criteria (CTP),4 TNM staging,5 the French staging system,6 the Cancer of the Liver Italian Program (CLIP),1 the Chinese University Prognostic Index (CUPI),7 the Japanese integrated staging system (JIS)8 and biomarker JIS (bm-JIS),9 Barcelona Clinic Liver Cancer (BCLC) staging,10,11 etc. Different staging systems used for HCC are compared in Table 2.
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2014, Acta Anaesthesiologica TaiwanicaCitation Excerpt :Therefore, data from 15 patients in the control group and 16 patients in the liver dysfunction group were analyzed in this study. To classify the patients according to their liver function, we used the Liver Damage (LD) classification system, which consists of measuring five items (Table 1).18–21 The degree of LD as a guide to liver function was defined by the Liver Cancer Study Group of Japan based on ascites, serum bilirubin, serum albumin, indocyanine green retention rate at 15 minutes (ICGR15), and prothrombin activity.
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2010, HPBCitation Excerpt :There is consensus among experts that a HCC staging system should be retrospectively and prospectively validated in the patient populations where its use is proposed.1,4,7,9 Recent studies comparing HCC staging systems to one another evaluated the ability to discriminate outcomes in particular patient populations subjected to specific therapies.12–21 Most staging systems studied perform poorly when the study population includes a cohort of patients with a wide spectrum of diseases and tumor stages.
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2007, Annals of Thoracic SurgeryCitation Excerpt :Liver damage class, according to the Liver Cancer Study Group of Japan, is another useful and more accurate classification for severely impaired liver function, compared with Child-Pugh classification (Table 2). In Japan, this liver damage grading is widely used in diagnosis and treatment in patients with hepatocellular carcinoma (HCC) complicated with liver cirrhosis, and is considered to be more closely correlated with clinical outcome than is the Child-Pugh class [12, 13]. Concurrent appearance of HCC at the time of lung surgery was investigated, because liver malignancy often arises in cirrhotic liver and may shorten life expectancy [4, 14–16].