A new Child-Turcotte-Pugh class 0 for patients with hepatocellular carcinoma: determinants, prognostic impact and ability to improve the current staging systems

• Published in: PloS one Vol. 9; no. 6; p. e99115
• Main Authors: Lee, Yun-Hsuan, Hsu, Chia-Yang, Chu, Chen-Wei, Liu, Po-Hong, Hsia, Cheng-Yuan, Huang, Yi-Hsiang, Su, Chien-Wei, Chiou, Yi-You, Lin, Han-Chieh, Huo, Teh-Ia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.06.2014; Public Library of Science (PLoS)
• Subjects: Alanine; Alanine transaminase; Alcoholism; Ascites; Bilirubin; Blood tests; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Care and treatment; Classification; Creatinine; Disease-Free Survival; Encephalopathy; Female; Glycoproteins; Hazards; Hepatic encephalopathy; Hepatocellular carcinoma; Hospitals; Humans; Impact analysis; Liver; Liver cancer; Liver diseases; Liver Neoplasms - blood; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Medical imaging; Medical prognosis; Medicine; Medicine and Health Sciences; Neoplasm Staging; Nodules; Patients; Predictions; Predictive Value of Tests; Prolongation; Prothrombin; Research and Analysis Methods; Retrospective Studies; Sodium; Statistical models; Surgery; Survival Rate; Thrombin; Transplants & implants; Los Angeles California; California; United States > US; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0099115

Majority of patients with hepatocellular carcinoma (HCC) belonged to Child-Turcotte-Pugh (CTP) class A. We aimed to identify a new class of patients with very well-preserved liver function and analyze its impact on outcome prediction, tumor staging and treatment allocation. A total of 2654 HCC patients were retrospectively analyzed. The prognostic ability was compared by the Akaike information criterion (AIC). The CTP class 0 was defined by fulfilling all criteria of albumin ≧4 g/dL, bilirubin ≦0.8 mg/dL, prothrombin time prolongation <0 seconds, no ascites and encephalopathy. A total of 23% of patients of CTP class A were reclassified as CTP class 0. Patients with CTP class 0 had a higher serum sodium level, lower serum creatinine, alanine aminotransferase, α-fetoprotein levels, shorter prothrombin time, better general well-being, smaller tumor burden with more solitary nodules, lower rates of vascular invasion, ascites formation, hepatic encephalopathy, more frequently treated with curative interventions and better Barcelona Clinic Liver Cancer (BCLC) stages (all p<0.001). In the Cox proportional hazards model, the adjusted hazard ratios for CTP class A, B and C were 1.739, 3.120 and 5.107, respectively, compared to class 0 (all p<0.001). Reassigning patients with CTP class 0, A, B, B and C to stage 0, A, B, C and D, respectively, provided the lowest AIC score among all BCLC-based models. The proposal of CTP class 0 independently predicted better survival in HCC patients. Modification of tumor staging systems according to the modified CTP classification further enhances their prognostic ability.