A New Child-Turcotte-Pugh Class 0 for Patients with Hepatocellular Carcinoma: Determinants, Prognostic Impact and Ability to Improve the Current Staging Systems

作者：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^*

来源：PLos One, 2014, 9(6): e99115.

DOI：10.1371/journal.pone.0099115

Background/Aim: 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. %26lt;br%26gt;Methods: A total of 2654 HCC patients were retrospectively analyzed. The prognostic ability was compared by the Akaike information criterion (AIC). %26lt;br%26gt;Results: The CTP class 0 was defined by fulfilling all criteria of albumin %26gt;= 4 g/dL, bilirubin %26lt;= 0.8 mg/dL, prothrombin time prolongation %26lt;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, afetoprotein 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%26lt;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%26lt;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. %26lt;br%26gt;Conclusions: 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.

• 出版日期2014-6-6