Comparative analysis of the modern staging systems of hepatocellular carcinoma – TNM/AJCC, CUPI, CLIP and BCLC from everyday clinical practice in Russia. The experience of Russian Oncological Scientific Center n. a. N. N. Blokhin

Aims: to explore the prognostic and practical utilit y of several internationally validated hepatocellular cancer (HCC) staging systems for Russian patient’s cohor t.
Methods: retrospective trial of 380 HCC cases referred to Russian Cancer Research center n. a.N.N.Blokhin from Jan 2006 till Dec 2015.
Results: median follow-up duration was 16,5 months. All HCC staging systems showed statistical significance for prognosis by univariate analysis: TNM/AJCC (p<0,0001; HR1,294; 95% CI 1,207–1,398); BCLC (p<0,0001; HR1,782; 95% CI 1,518–2,093); CLIP (p<0,0001; HR1,777; 95% CI 1,565–2,017); CUPI (p<0,0001; HR2,537; 95% CI 1,985–3,234). Significant sur vival difference was found across groups of early and late TNM/AJCC stages only. At multivariate analysis, prognosis was independently predicted by CUPI (HR1,512, р=0,004), CLIP (HR1,392, р<0,0001) and BCLC (HR1,337, р=0,001) for Russian patient’s cohort.
Conclusions: the Barcelona Clinic Liver Cancer (BCLC) system was shown to have excellent discrimination of survival in patients with HCC and had a practically meaningful for Russian HCC patient’s cohort staging. BCLC staging and Child-Pugh-driven liver function assessment have to be obligatory supplement to TNM/AJCC in HCC diagnosis.

1. Mittal S., El-Serag H. B. Epidemiology of HCC: Consider the Population // J. Clin. Gastroenterol. 2013. Т. 47, № 0. С. 1–10.

2. Au J. S., Frenette C. T. Management of Hepatocellular Carcinoma: Current Status and Future Directions // Gut Liver. 2015. Т. 9, № 4. С. 437–448.

3. Chapiro J., Geschwind J. – F. Hepatocellular carcinoma: Have we finally found the ultimate staging system for HCC? // Nat. Rev. Gastroenterol. Hepatol. Nature Publishing Group, 2014. Т. 11, № 6. С. 334–336.

4. Greene F. L., Sobin L. H. The staging of cancer: a retrospective and prospective appraisal. // CA. Cancer J. Clin. Т. 58, № 3. С. 180–190.

5. AJCC Cancer Staging Manual | Stephen Edge | Springer [Электронный ресурс]. URL: http://www.springer.com/us/book/9780387884400 (дата обращения: 22.03.2016).

6. Okuda K. и др. Natural history of hepatocellular carcinoma and prognosis in relation to treatment study of 850 patients // Cancer. 1985. Т. 56, № 4. С. 918–928.

7. Grieco A. и др. Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre. // Gut. 2005. Т. 54, № 3. С. 411–418.

8. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. // Hepatology. 1998. Т. 28, № 3. С. 751–755.

9. Kudo M., Chung H., Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). // J. Gastroenterol. 2003. Т. 38, № 3. С. 207–215.

10. Leung T. W.T. и др. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. // Cancer. 2002. Т. 94, № 6. С. 1760–1769.

11. Llovet J. M., Br C., Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. // Semin. Liver Dis. 1999. Т. 19, № 3. С. 329–338.

12. Bruix J. и др. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona‑2000 EASL conference. European Association for the Study of the Liver. // J. Hepatol. 2001. Т. 35, № 3. С. 421–430.

13. Forner A. и др. Hepatocellular carcinoma. // Lancet. Elsevier, 2012. Т. 379, № 9822. С. 1245–1255.

14. Pugh R. N. и др. Transection of the oesophagus for bleeding oesophageal varices. // Br. J. Surg. 1973. Т. 60, № 8. С. 646–649.

15. Tormey и др. ECOG performance status // Am. J. Clin. Oncol. 1982. Т. 5. С. 649–655.

16. Comprehensive N., Network C. Hepatobiliary Cancers // NCCN Clin. Pract. Guidel. Oncol. 2013. Т. I. С. 1–94.

17. Yau T. и др. Development of Hong Kong liver cancer staging system with treatment stratification for patients with hepatocellular carcinoma. // Gastroenterology. Elsevier, Inc, 2014. Т. 146, № 7. С. 1691–1700.e3.