Sub-classification of Advanced-Stage Hepatocellular Carcinoma: A Cohort Study Including 612 Patients Treated with Sorafenib

Jeong-Ju Yoo, Goh Eun Chung, Jeong-Hoon Lee, Joon Yeul Nam, Young Chang, Jeong Min Lee, Dong Ho Lee, Hwi Young Kim, Eun Ju Cho, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon

Advanced hepatocellular carcinoma (HCC) is associated with various clinical conditions including major vessel invasion, metastasis, and poor performance status. The aim of this study was to establish a prognostic scoring system and to propose a sub-classification of the Barcelona-Clinic Liver Cancer (BCLC) stage C. This retrospective study included consecutive patients who received sorafenib for BCLC stage C HCC at a single tertiary hospital in Korea. A Cox proportional hazard model was used to develop a scoring system, and internal validation was performed by a 5-fold cross-validation. The performance of the model in predicting risk was assessed by the area under the curve and the Hosmer-Lemeshow test. A total of 612 BCLC stage C HCC patients were sub- classified into strata depending on their performance status. Five independent prognostic factors (Child-Pugh score, alpha-fetoprotein, tumor type, extrahepatic metastasis, and portal vein invasion) were identified and used in the prognostic scoring system. This scoring system showed good discrimination (area under the ROC curve, 0.734-0.818) and calibration functions (both P < 0.05 by the Hosmer-Lemeshow test at months 1 and 12, respectively). The differences in survival among the different risk groups classified by the total score were significant. (P <0.001 by the log-rank test in both the ECOG 0 and 1 strata). The heterogeneity of patients with BCLC stage C HCC requires sub-classification of advanced HCC. A prognostic scoring system with five independent factors is useful in predicting the survival of patients with BCLC stage C HCC.