Selection of treatment modality for hepatocellular carcinoma according to the modified Japan Integrated Staging score

Table 1A Definition and criteria of the TNM stage for HCC according to the Liver Cancer Study Group of Japan[17]

Factor of T category
1 Number of tumors: 1
2 Tumor size: no more than 2 cm
3 No vascular or bile duct invasion
T category	T1: Fulfilling all three factors
	T2: Fulfilling two factors
	T3: Fulfilling one factor
	T4: Fulfilling none of the factors
N category	N0: Absence of lymph node metastasis
	N1: Presence of lymph node metastasis
M category	M0: Absence of distant metastasis
	M1: Presence of distant metastasis
Stage I	T1 N0 M0
Stage II	T2 N0 M0
Stage III	T3 N0 M0
Stage IV-A	T4 N0 M0 or T1-T4, N1M0
Stage IV-B	T1-4, N0 or 1, M1

Table 1B Definition and criteria of Child-Pugh classification and liver damage grade

Child-Pugh classification[24]		A	B	C
Encephalopathy		none	mild	coma
Ascites		none	responsive	unresponsive
Serum bilirubin (mg/dL)		< 2.0	2.0-3.0	> 3.0
Serum albumin (g/dL)		> 3.5	2.8-3.5	< 2.8
Prothrombin activity (%)		> 70	40-70	< 40
Liver damage grade[17]		A	B	C
Ascites		none	responsive	unresponsive
Serum bilirubin (mg/dL)		< 2.0	2.0-3.0	> 3.0
Serum albumin (g/dL)		> 3.5	3.0-3.5	< 3.0
ICG R15 (%)		< 15	15-40	> 40
Prothrombin activity (%)		> 80	50-80	< 50

Table 1C Definition and criteria of the JIS and the mJIS

	Score
	0	1	2	3
Original JIS score[6]
Japanese TNM stage	I	II	III	IV
Child-Pugh Classification	A	B	C
Modified JIS score[9]
Japanese TNM stage	I	II	III	IV
Liver damage grade	A	B	C

TNM: Tumor-node metastasis.

Table 2 Patient demographics between two groups in HCC patients

	Operation	Ablation	P-value
	(n = 226)	(n = 52)
Age (yr)	60.2 ± 10.5	58.3 ± 10.7	0.074
Gender
male/female	179/43	37/15	0.283
Time to treatment (yr)1	(5.1, 8.4, 11.2)	(5.4, 9.3, 11.6)	0.28
Background liver
chronic hepatitis/cirrhosis/normal	119/94/13	4/48/0	< 0.001
Hepatitis virus
B/C/B&C/non-B non-C	72/116/11/27	11/36/5/0	0.007
Child-Pugh classification
A/B	201/25	34/18	< 0.001
Pretreatment
Yes/No	78/148	0/52	< 0.001
Tumor size
< 5 cm/≥ 5 cm	160/66	49/3	< 0.001
Number of tumors
solitary/multiple	174/52	37/15	0.479
Vascular involvement
No/Yes	162/64	48/4	0.003
Adjuvant therapy
Yes/No	5/221	0/52	0.615

¹Each triplet gives the 25^th, 50^th and 75^th sample percentiles. Time to the treatment since 1 January 1994.

Table 3 Survival between two groups in HCC patients by multivariate analysis

	Disease-free survival		Overall survival
	HR (95% CI)	P-value	HR (95% CI)	P-value
Child-Pugh classification
B vs A	2.05 (1.25-3.35)	0.004	2.46 (1.38-4.41)	0.002
Tumor size
≥ 5 vs < 5 cm	1.26 (0.83-1.92)	0.282	1.30 (0.75-2.25)	0.350
Macroscopic findings1
Confluent type vs	1.10 (0.75-1.61)	0.626	1.58 (0.92-2.72)	0.098
Simple nodular type
Number of tumor
Multiple vs Solitary	1.23 (0.82-1.85)	0.306	1.73 (1.03-2.91)	0.037
Vascular involvement
Yes vs No	1.24 (0.68-2.27)	0.481	1.76 (0.93-3.31)	0.080
Alpha-feto protein level
≥ 400 vs < 400 ng/mL	1.41 (0.93-2.11)	0.103	1.36 (0.81-2.28)	0.250
Treatment modality
Ablation vs Hepatectomy	0.75 (0.46-1.22)	0.239	0.64 (0.39-1.34)	0.334

¹Macroscopic findings defined by the Classification of Primary Liver Cancer[17].

Table 4 The 3-year survival rates in each score of mJIS after treatments in HCC patients

	Operation group (n = 226) (%)	Ablation group (n = 52) (%)
mJIS 0	96	98
mJIS 1	80	73
mJIS 2	66	70
mJIS 3	39	48
mJIS 4	35	28
mJIS 5	25	-