Development of a prognostic scoring system for resectable hepatocellular carcinoma

Table 1 Baseline patients’ characteristics and comparison between the training and validation sets n (%)

	Training set (n = 480)	Validation set (n = 437)	P value
Age (yr)	67 (61-73)	68 (61-73)	0.684
Gender, male	374 (77.9)	331 (75.7)	0.436
ECOG PS			0.362
0	452 (94.2)	405 (92.7)
1-2	28 (5.8)	32 (7.3)
Child-Pugh			0.118
A	453 (94.4)	401 (91.8)
B	27 (5.6)	36 (8.2)
MELD score	8 (7-10)	8 (7-10)	0.791
Etiology			0.516
Cryptogenic	104 (21.7)	88 (20.1)
HBV only	94 (19.6)	71 (16.2)
HCV only	222 (46.25)	217 (49.7)
Alcohol	48 (10.0)	45 (10.3)
HBV + HCV	12 (2.5)	16 (3.7)
HCV infection	247 (51.5)	246 (56.3)	0.142
Portal hypertension	165 (34.4)	155 (35.5)	0.728
Platelet count (103/μL)	157 (25-505)	154 (26-914)	0.779
AFP, ng/mL (n = 663)	14.3 (4.7-121.5)	11.4 (4.3-71)	0.160
ICG-R15 (n = 400)	15 (6.1-25)	16 (7.7-22.3)	0.424
Total bilirubin (≥ 1.2 mg/dL)	148 (30.8)	126 (28.8)	0.509
Number of lesions (> 3)	10 (2.1)	10 (2.3)	0.832
Largest diameter (> 5 cm)	143 (29.8)	124 (28.4)	0.637
Portal invasion	22 (4.6)	14 (3.2)	0.283
Extent of hepatectomy (major)	85 (17.7)	78 (17.8)	0.956
Follow-up status (dead)	240 (50.0)	202 (46.2)	0.253
Follow-up time (mo)	35.9 (16.3-61.0)	32.5 (16.7-55.8)	0.254
Overall survival	59.3 (50.2-66.6)	56.4 (47.0-75.8)	0.833

Continuous variables are reported as median values and interquartile range, categorical variables as the number of cases and percentage. Patients’ characteristics in the two sets are compared using the Pearson χ² test (or Fisher exact test, if necessary) for categorical variables, the Student t-test for continuous variables and the log-rank test for time-to-event data. ECOG PS: Eastern Cooperative Oncology Group Performance Status; MELD: Model for End-stage Liver Disease; AFP: α-fetoprotein; ICG-R15: Indocyanine green retention test at 15 min.

Table 2 Multivariable Cox proportional hazards regression model (training set) and relative point system

Variable	HR	95%CI	P value	β	Points
MELD score ≤ 9					0
MELD score > 9	1.444	(1.080-1.931)	0.013	0.3674	1
HCV infection absent					0
HCV infection present	1.468	(1.112-1.937)	0.007	0.3839	1
Number of lesions ≤ 3					0
Number of lesions > 3	3.253	(1.434-7.380)	0.005	1.1795	3
Largest diameter ≤ 5 cm					0
Largest diameter > 5 cm	1.459	(1.085-1.963)	0.012	0.3779	1
Portal invasion absent					0
Portal invasion present	3.500	(2.016-6.073)	< 0.001	1.2526	3

MELD: End-stage Liver Disease; HCV: Hepatitis C virus.

Table 3 Median overall survival and 1- 3- and 5-year survival probabilities for ideal and non-ideal candidates for liver resection according to European Association for the Study of the Liver/American Association for the Study of Liver Diseases and the current study

		No. Of patients (%)	Median OS (95%CI)	5-yr OS	10-yr OS
EASL/AASLD	Ideal	323 (37.8)	83 (73-108)	64.4	37.0
	Non-ideal	531 (62.2)	46 (41-52)	42.0	21.2
Current study	Ideal	593 (69.4)	77 (64-44)	57.2	31.2
	Non-ideal	261 (30.6)	38 (30-44)	35.8	20.0

EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases.