Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection
Background: For Chinese patients with hepatocellular carcinoma (HCC), surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor, and yet the prognosis after surgery is diverse. We aimed to construct a scoring system (Shanghai Score) for i...
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doaj-ee49e02b78cb40b3853111cc0ae34bd92020-11-24T20:49:52ZengWolters KluwerChinese Medical Journal0366-69992017-01-01130222650266010.4103/0366-6999.218019Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative ResectionHui-Chuan SunLu XieXin-Rong YangWei LiJian YuXiao-Dong ZhuYong XiaTi ZhangYang XuBo HuLi-Ping DuLing-Yao ZengJian OuyangWei ZhangTian-Qiang SongQiang LiYing-Hong ShiJian ZhouShuang-Jian QiuQian LiuYi-Xue LiZhao-You TangYu ShyrFeng ShenJia FanBackground: For Chinese patients with hepatocellular carcinoma (HCC), surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor, and yet the prognosis after surgery is diverse. We aimed to construct a scoring system (Shanghai Score) for individualized prognosis estimation and adjuvant treatment evaluation. Methods: A multivariate Cox proportional hazards model was constructed based on 4166 HCC patients undergoing resection during 2001–2008 at Zhongshan Hospital. Age, hepatitis B surface antigen, hepatitis B e antigen, partial thromboplastin time, total bilirubin, alkaline phosphatase, γ-glutamyltransferase, α-fetoprotein, tumor size, cirrhosis, vascular invasion, differentiation, encapsulation, and tumor number were finally retained by a backward step-down selection process with the Akaike information criterion. The Harrell's concordance index (C-index) was used to measure model performance. Shanghai Score is calculated by summing the products of the 14 variable values times each variable's corresponding regression coefficient. Totally 1978 patients from Zhongshan Hospital undergoing resection during 2009–2012, 808 patients from Eastern Hepatobiliary Surgery Hospital during 2008–2010, and 244 patients from Tianjin Medical University Cancer Hospital during 2010–2011 were enrolled as external validation cohorts. Shanghai Score was also implied in evaluating adjuvant treatment choices based on propensity score matching analysis. Results: Shanghai Score showed good calibration and discrimination in postsurgical HCC patients. The bootstrap-corrected C-index (confidence interval [CI]) was 0.74 for overall survival (OS) and 0.68 for recurrence-free survival (RFS) in derivation cohort (4166 patients), and in the three independent validation cohorts, the CI s for OS ranged 0.70–0.72 and that for RFS ranged 0.63–0.68. Furthermore, Shanghai Score provided evaluation for adjuvant treatment choices (transcatheter arterial chemoembolization or interferon-α). The identified subset of patients at low risk could be ideal candidates for curative surgery, and subsets of patients at moderate or high risk could be recommended with possible adjuvant therapies after surgery. Finally, a web server with individualized outcome prediction and treatment recommendation was constructed. Conclusions: Based on the largest cohort up to date, we established Shanghai Score – an individualized outcome prediction system specifically designed for Chinese HCC patients after surgery. The Shanghai Score web server provides an easily accessible tool to stratify the prognosis of patients undergoing liver resection for HCC.http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=22;spage=2650;epage=2660;aulast=SunAdjuvant Treatment; Hepatocellular Carcinoma; Prognosis; Shanghai Score |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hui-Chuan Sun Lu Xie Xin-Rong Yang Wei Li Jian Yu Xiao-Dong Zhu Yong Xia Ti Zhang Yang Xu Bo Hu Li-Ping Du Ling-Yao Zeng Jian Ouyang Wei Zhang Tian-Qiang Song Qiang Li Ying-Hong Shi Jian Zhou Shuang-Jian Qiu Qian Liu Yi-Xue Li Zhao-You Tang Yu Shyr Feng Shen Jia Fan |
spellingShingle |
Hui-Chuan Sun Lu Xie Xin-Rong Yang Wei Li Jian Yu Xiao-Dong Zhu Yong Xia Ti Zhang Yang Xu Bo Hu Li-Ping Du Ling-Yao Zeng Jian Ouyang Wei Zhang Tian-Qiang Song Qiang Li Ying-Hong Shi Jian Zhou Shuang-Jian Qiu Qian Liu Yi-Xue Li Zhao-You Tang Yu Shyr Feng Shen Jia Fan Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection Chinese Medical Journal Adjuvant Treatment; Hepatocellular Carcinoma; Prognosis; Shanghai Score |
author_facet |
Hui-Chuan Sun Lu Xie Xin-Rong Yang Wei Li Jian Yu Xiao-Dong Zhu Yong Xia Ti Zhang Yang Xu Bo Hu Li-Ping Du Ling-Yao Zeng Jian Ouyang Wei Zhang Tian-Qiang Song Qiang Li Ying-Hong Shi Jian Zhou Shuang-Jian Qiu Qian Liu Yi-Xue Li Zhao-You Tang Yu Shyr Feng Shen Jia Fan |
author_sort |
Hui-Chuan Sun |
title |
Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection |
title_short |
Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection |
title_full |
Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection |
title_fullStr |
Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection |
title_full_unstemmed |
Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection |
title_sort |
shanghai score: a prognostic and adjuvant treatment-evaluating system constructed for chinese patients with hepatocellular carcinoma after curative resection |
publisher |
Wolters Kluwer |
series |
Chinese Medical Journal |
issn |
0366-6999 |
publishDate |
2017-01-01 |
description |
Background: For Chinese patients with hepatocellular carcinoma (HCC), surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor, and yet the prognosis after surgery is diverse. We aimed to construct a scoring system (Shanghai Score) for individualized prognosis estimation and adjuvant treatment evaluation.
Methods: A multivariate Cox proportional hazards model was constructed based on 4166 HCC patients undergoing resection during 2001–2008 at Zhongshan Hospital. Age, hepatitis B surface antigen, hepatitis B e antigen, partial thromboplastin time, total bilirubin, alkaline phosphatase, γ-glutamyltransferase, α-fetoprotein, tumor size, cirrhosis, vascular invasion, differentiation, encapsulation, and tumor number were finally retained by a backward step-down selection process with the Akaike information criterion. The Harrell's concordance index (C-index) was used to measure model performance. Shanghai Score is calculated by summing the products of the 14 variable values times each variable's corresponding regression coefficient. Totally 1978 patients from Zhongshan Hospital undergoing resection during 2009–2012, 808 patients from Eastern Hepatobiliary Surgery Hospital during 2008–2010, and 244 patients from Tianjin Medical University Cancer Hospital during 2010–2011 were enrolled as external validation cohorts. Shanghai Score was also implied in evaluating adjuvant treatment choices based on propensity score matching analysis.
Results: Shanghai Score showed good calibration and discrimination in postsurgical HCC patients. The bootstrap-corrected C-index (confidence interval [CI]) was 0.74 for overall survival (OS) and 0.68 for recurrence-free survival (RFS) in derivation cohort (4166 patients), and in the three independent validation cohorts, the CI s for OS ranged 0.70–0.72 and that for RFS ranged 0.63–0.68. Furthermore, Shanghai Score provided evaluation for adjuvant treatment choices (transcatheter arterial chemoembolization or interferon-α). The identified subset of patients at low risk could be ideal candidates for curative surgery, and subsets of patients at moderate or high risk could be recommended with possible adjuvant therapies after surgery. Finally, a web server with individualized outcome prediction and treatment recommendation was constructed.
Conclusions: Based on the largest cohort up to date, we established Shanghai Score – an individualized outcome prediction system specifically designed for Chinese HCC patients after surgery. The Shanghai Score web server provides an easily accessible tool to stratify the prognosis of patients undergoing liver resection for HCC. |
topic |
Adjuvant Treatment; Hepatocellular Carcinoma; Prognosis; Shanghai Score |
url |
http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=22;spage=2650;epage=2660;aulast=Sun |
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