External validation of the ITA.LI.CA prognostic system for patients with hepatocellular carcinoma: A multicenter cohort study. (HEP-17-0903)

Abstract

Several staging systems for HCC have been developed. BCLC is considered the best in predicting survival, although limitations have emerged. Recently the Italian-Liver-Cancer (ITA.LI.CA) prognostic system, integrating the ITA.LI.CA tumor-staging (stages 0, A, B1-3; C) with Child-Pugh score, ECOG-PST, and AFP with a strong ability to predict survival was proposed. Aim of our study was to provide an external validation of the ITA.LI.CA system in an independent real-life occidental cohort of HCCs.

Methods: From September 2008 to April 2016, 1508 cirrhotics with incident HCC were consecutively enrolled in 27 Italian institutions (EpaHCC multi-institutional cohort). Clinical, tumor and treatment-related variables were collected and patients stratified according to BCLC, ITA.LI.CA prognostic system, HKLC, CLIP, JIS, and MESIAH scores. Harrel's C-index, Akaike-Information-Criterion and likelihood-ratio test were used to compare predictive ability of different systems. A subgroup analysis for treatment category (curative vs palliative) was performed.

Results: Median follow-up was 44 months (IQR 23-63) and median OS was 34 (IQR 13-82). Median age was 71 years, and patients were mainly males and HCV carriers. According to ITA.LI.CA tumor staging 246 patients were in stage-0, 472 in stage-A; 657 in the stages-B1/3; 133 in stage-C. ITA.LI.CA prognostic system showed the best discriminatory ability (C-index = 0.77) and monotonicity of gradients, compared to other systems, and the superiority was also confirmed after stratification for treatment strategy.

Conclusions: This is the first study that independently validated the ITA.LI.CA prognostic system in a large cohort of Western patients with incident HCCs. ITA.LI.CA-system performed better than other multidimensional prognostic systems even after stratification by curative or palliative treatment. This new system appears to be particularly useful to predict individual HCC prognosis in clinical practice. This article is protected by copyright. All rights reserved.

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