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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695048/ https://www.ncbi.nlm.nih.gov/pubmed/29133751 http://dx.doi.org/10.4103/0366-6999.218019 |
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author | Sun, Hui-Chuan Xie, Lu Yang, Xin-Rong Li, Wei Yu, Jian Zhu, Xiao-Dong Xia, Yong Zhang, Ti Xu, Yang Hu, Bo Du, Li-Ping Zeng, Ling-Yao Ouyang, Jian Zhang, Wei Song, Tian-Qiang Li, Qiang Shi, Ying-Hong Zhou, Jian Qiu, Shuang-Jian Liu, Qian Li, Yi-Xue Tang, Zhao-You Shyr, Yu Shen, Feng Fan, Jia |
author_facet | Sun, Hui-Chuan Xie, Lu Yang, Xin-Rong Li, Wei Yu, Jian Zhu, Xiao-Dong Xia, Yong Zhang, Ti Xu, Yang Hu, Bo Du, Li-Ping Zeng, Ling-Yao Ouyang, Jian Zhang, Wei Song, Tian-Qiang Li, Qiang Shi, Ying-Hong Zhou, Jian Qiu, Shuang-Jian Liu, Qian Li, Yi-Xue Tang, Zhao-You Shyr, Yu Shen, Feng Fan, Jia |
author_sort | Sun, Hui-Chuan |
collection | PubMed |
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 CIs 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. |
format | Online Article Text |
id | pubmed-5695048 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-56950482017-12-04 Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection Sun, Hui-Chuan Xie, Lu Yang, Xin-Rong Li, Wei Yu, Jian Zhu, Xiao-Dong Xia, Yong Zhang, Ti Xu, Yang Hu, Bo Du, Li-Ping Zeng, Ling-Yao Ouyang, Jian Zhang, Wei Song, Tian-Qiang Li, Qiang Shi, Ying-Hong Zhou, Jian Qiu, Shuang-Jian Liu, Qian Li, Yi-Xue Tang, Zhao-You Shyr, Yu Shen, Feng Fan, Jia Chin Med J (Engl) Original Article 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 CIs 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. Medknow Publications & Media Pvt Ltd 2017-11-20 /pmc/articles/PMC5695048/ /pubmed/29133751 http://dx.doi.org/10.4103/0366-6999.218019 Text en Copyright: © 2017 Chinese Medical Journal http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Sun, Hui-Chuan Xie, Lu Yang, Xin-Rong Li, Wei Yu, Jian Zhu, Xiao-Dong Xia, Yong Zhang, Ti Xu, Yang Hu, Bo Du, Li-Ping Zeng, Ling-Yao Ouyang, Jian Zhang, Wei Song, Tian-Qiang Li, Qiang Shi, Ying-Hong Zhou, Jian Qiu, Shuang-Jian Liu, Qian Li, Yi-Xue Tang, Zhao-You Shyr, Yu Shen, Feng Fan, Jia Shanghai Score: A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection |
title | 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_short | 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 |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695048/ https://www.ncbi.nlm.nih.gov/pubmed/29133751 http://dx.doi.org/10.4103/0366-6999.218019 |
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