Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2025; 17(5): 104041
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.104041
Comparative prognostic performance of staging systems for hepatocellular carcinoma: Evidence from a Vietnamese cohort study
Tuong-Anh Mai-Phan, Trong-Kha Nguyen, Tri-Nhan Pham, Minh-Quang Tran, Kim-Long Le
Tuong-Anh Mai-Phan, Trong-Kha Nguyen, Tri-Nhan Pham, Minh-Quang Tran, Kim-Long Le, Department of Hepato-Pancreato-Biliary, Nhan dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam
Tuong-Anh Mai-Phan, Medicine Faculty, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
Tri-Nhan Pham, Minh-Quang Tran, Kim-Long Le, Department of Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam
Author contributions: Mai-Phan TA and Nguyen TK designed the study; Mai-Phan TA supervised the generation of the study; Nguyen TK was responsible for developing the methodology; Le KL and Nguyen TK participated in the formal and statistical data analysis, and overall investigation; Nguyen TK, Le KL, Tran MQ, and Pham TN wrote the original draft; Pham TN and Tran MQ were responsible for the data visualization; Mai-Phan TA, Le KL, Nguyen TK, Tran MQ, and Pham TN participated in the review and editing of the manuscript; Le KL and Mai-Phan TA reviewed and edited the successive versions of the manuscript; All authors reviewed and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of Nhan dan Gia Dinh Hospital (Approval No. 127/NDGD-HDDD).
Informed consent statement: As this was a retrospective cohort study utilizing data from existing medical records, the requirement for obtaining signed informed consent forms was waived by the ethics committee in accordance with applicable ethical guidelines, including the Declaration of Helsinki. Patient confidentiality and data protection were ensured throughout the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author, Kim-Long Le, upon reasonable request. Access to the data will be granted provided that the request complies with ethical guidelines and data protection regulations, including maintaining patient confidentiality as per the Declaration of Helsinki and institutional policies.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kim-Long Le, MD, Lecturer, Department of Hepato-Pancreato-Biliary, Nhan dan Gia Dinh Hospital, 1 No Trang Long, Ward 7, Binh Thanh District, Ho Chi Minh City 07000, Viet Nam. longlk@pnt.edu.vn
Received: December 9, 2024
Revised: February 19, 2025
Accepted: April 17, 2025
Published online: May 27, 2025
Processing time: 170 Days and 13 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC), the sixth most common cancer and fourth-leading cause of cancer-related mortality globally, imposes a significant burden in Vietnam due to endemic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Accurate prognostication is crucial for optimizing treatment and outcomes. Numerous staging systems exist, including the Barcelona Clinic Liver Cancer (BCLC), Hong Kong Liver Cancer (HKLC), cancer of the liver Italian Program (CLIP), Italian Liver Cancer (ITA.LI.CA), Japan Integrated Staging (JIS), Tokyo Score, and model to estimate survival in ambulatory HCC patients (MESIAH). However, their comparative performance in Vietnamese patients remains underexplored.

AIM

To compare the prognostic accuracy of seven HCC staging systems in predicting survival and identify the optimal model.

METHODS

This retrospective cohort study included 987 patients with HCC diagnosed at Nhan dan Gia Dinh Hospital, Vietnam, from January 2016 to December 2023. Patients were staged using BCLC, HKLC, CLIP, ITA.LI.CA, JIS, Tokyo score, and MESIAH. Overall survival was analyzed using Kaplan-Meier methods, and prognostic performance was evaluated via the area under the receiver operating characteristic (ROC) curve, Harrell’s concordance index, and calibration plots.

RESULTS

The HKLC and BCLC systems demonstrated the highest discriminatory ability, with area under the ROC curves of 0.834 and 0.830, respectively, at 12 months and 0.859 for both systems at 36 months. CLIP and ITA.LI.CA exhibited superior calibration, particularly at 36 months. The JIS system consistently showed the poorest discriminatory performance. Subgroup analyses revealed that HKLC maintained strong performance across different viral etiologies (HBV, HCV, non-B-non-C) and treatment modalities (transarterial chemoembolization, surgery, ablation).

CONCLUSION

The HKLC and BCLC systems showed superior prognostic performance for Vietnamese patients with HCC, supporting HKLC adoption in clinical practice.

Keywords: Hepatocellular carcinoma; Prognostic staging systems; Barcelona Clinic Liver Cancer; Hong Kong Liver Cancer; Survival analysis; Prognostic performance; Non-B-non-C; Retrospective cohort study; Vietnam; Viral hepatitis B; Viral hepatitis C

Core Tip: The Hong Kong Liver Cancer (HKLC) staging system demonstrated superior prognostic accuracy in Vietnamese patients with hepatocellular carcinoma (HCC), outperforming other established models such as, cancer of the liver Italian program, and Italian liver cancer. These findings highlight the HKLC system’s clinical utility, particularly in stratifying risk and guiding treatment decisions for Asian populations with diverse viral etiologies. Notably, patients with non-viral HCC exhibited poorer outcomes, emphasizing the need for improved screening strategies in this subgroup to enhance early detection and survival.