Model to estimate survival in ambulatory patients with hepatocellular carcinoma

Ju Dong Yang, W. Ray Kim, Kyung Woo Park, Roongruedee Chaiteerakij, Bohyun Kim, Schuyler O. Sanderson, Joseph J. Larson, Rachel A. Pedersen, Terry M Therneau, Gregory James Gores, Lewis Rowland Roberts, Joong Won Park

Research output: Contribution to journalArticle

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Abstract

Survival of patients with hepatocellular carcinoma (HCC) is determined by the extent of the tumor and the underlying liver function. We aimed to develop a survival model for HCC based on objective parameters including the Model for Endstage Liver Disease (MELD) as a gauge of liver dysfunction. This analysis is based on 477 patients with HCC seen at Mayo Clinic Rochester between 1994 and 2008 (derivation cohort) and 904 patients at the Korean National Cancer Center between 2000 and 2003 (validation cohort). Multivariate proportional hazards models and corresponding risk score were created based on baseline demographic, clinical, and tumor characteristics. Internal and external validation of the model was performed. Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores. The majority of the patients had viral hepatitis as the underlying liver disease (100% in the derivation cohort and 85% in the validation cohort). The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha-fetoprotein. In cross-validation, the coefficients remained largely unchanged between iterations. Observed survival in the validation cohort matched closely with what was predicted by the model. The concordance (c)-statistic for this model (0.77) was superior to that for BCLC (0.71), CLIP (0.70), or JIS (0.70). The score was able to further classify patient survival within each stage of the BCLC classification. Conclusion: A new model to predict survival of HCC patients based on objective parameters provides refined prognostication and supplements the BCLC classification.

Original languageEnglish (US)
Pages (from-to)614-621
Number of pages8
JournalHepatology
Volume56
Issue number2
DOIs
StatePublished - Aug 2012

Fingerprint

Liver Neoplasms
Hepatocellular Carcinoma
Survival
Liver Diseases
Neoplasms
Japan
alpha-Fetoproteins
Proportional Hazards Models
Serum Albumin
Calibration
Hepatitis
Blood Vessels
Demography
Neoplasm Metastasis
Liver

ASJC Scopus subject areas

  • Hepatology

Cite this

Yang, J. D., Kim, W. R., Park, K. W., Chaiteerakij, R., Kim, B., Sanderson, S. O., ... Park, J. W. (2012). Model to estimate survival in ambulatory patients with hepatocellular carcinoma. Hepatology, 56(2), 614-621. https://doi.org/10.1002/hep.25680

Model to estimate survival in ambulatory patients with hepatocellular carcinoma. / Yang, Ju Dong; Kim, W. Ray; Park, Kyung Woo; Chaiteerakij, Roongruedee; Kim, Bohyun; Sanderson, Schuyler O.; Larson, Joseph J.; Pedersen, Rachel A.; Therneau, Terry M; Gores, Gregory James; Roberts, Lewis Rowland; Park, Joong Won.

In: Hepatology, Vol. 56, No. 2, 08.2012, p. 614-621.

Research output: Contribution to journalArticle

Yang, JD, Kim, WR, Park, KW, Chaiteerakij, R, Kim, B, Sanderson, SO, Larson, JJ, Pedersen, RA, Therneau, TM, Gores, GJ, Roberts, LR & Park, JW 2012, 'Model to estimate survival in ambulatory patients with hepatocellular carcinoma', Hepatology, vol. 56, no. 2, pp. 614-621. https://doi.org/10.1002/hep.25680
Yang JD, Kim WR, Park KW, Chaiteerakij R, Kim B, Sanderson SO et al. Model to estimate survival in ambulatory patients with hepatocellular carcinoma. Hepatology. 2012 Aug;56(2):614-621. https://doi.org/10.1002/hep.25680
Yang, Ju Dong ; Kim, W. Ray ; Park, Kyung Woo ; Chaiteerakij, Roongruedee ; Kim, Bohyun ; Sanderson, Schuyler O. ; Larson, Joseph J. ; Pedersen, Rachel A. ; Therneau, Terry M ; Gores, Gregory James ; Roberts, Lewis Rowland ; Park, Joong Won. / Model to estimate survival in ambulatory patients with hepatocellular carcinoma. In: Hepatology. 2012 ; Vol. 56, No. 2. pp. 614-621.
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abstract = "Survival of patients with hepatocellular carcinoma (HCC) is determined by the extent of the tumor and the underlying liver function. We aimed to develop a survival model for HCC based on objective parameters including the Model for Endstage Liver Disease (MELD) as a gauge of liver dysfunction. This analysis is based on 477 patients with HCC seen at Mayo Clinic Rochester between 1994 and 2008 (derivation cohort) and 904 patients at the Korean National Cancer Center between 2000 and 2003 (validation cohort). Multivariate proportional hazards models and corresponding risk score were created based on baseline demographic, clinical, and tumor characteristics. Internal and external validation of the model was performed. Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores. The majority of the patients had viral hepatitis as the underlying liver disease (100{\%} in the derivation cohort and 85{\%} in the validation cohort). The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha-fetoprotein. In cross-validation, the coefficients remained largely unchanged between iterations. Observed survival in the validation cohort matched closely with what was predicted by the model. The concordance (c)-statistic for this model (0.77) was superior to that for BCLC (0.71), CLIP (0.70), or JIS (0.70). The score was able to further classify patient survival within each stage of the BCLC classification. Conclusion: A new model to predict survival of HCC patients based on objective parameters provides refined prognostication and supplements the BCLC classification.",
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AU - Kim, W. Ray

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AU - Kim, Bohyun

AU - Sanderson, Schuyler O.

AU - Larson, Joseph J.

AU - Pedersen, Rachel A.

AU - Therneau, Terry M

AU - Gores, Gregory James

AU - Roberts, Lewis Rowland

AU - Park, Joong Won

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AB - Survival of patients with hepatocellular carcinoma (HCC) is determined by the extent of the tumor and the underlying liver function. We aimed to develop a survival model for HCC based on objective parameters including the Model for Endstage Liver Disease (MELD) as a gauge of liver dysfunction. This analysis is based on 477 patients with HCC seen at Mayo Clinic Rochester between 1994 and 2008 (derivation cohort) and 904 patients at the Korean National Cancer Center between 2000 and 2003 (validation cohort). Multivariate proportional hazards models and corresponding risk score were created based on baseline demographic, clinical, and tumor characteristics. Internal and external validation of the model was performed. Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores. The majority of the patients had viral hepatitis as the underlying liver disease (100% in the derivation cohort and 85% in the validation cohort). The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha-fetoprotein. In cross-validation, the coefficients remained largely unchanged between iterations. Observed survival in the validation cohort matched closely with what was predicted by the model. The concordance (c)-statistic for this model (0.77) was superior to that for BCLC (0.71), CLIP (0.70), or JIS (0.70). The score was able to further classify patient survival within each stage of the BCLC classification. Conclusion: A new model to predict survival of HCC patients based on objective parameters provides refined prognostication and supplements the BCLC classification.

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