A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire

J Hepatol. 1999 Jul;31(1):133-41. doi: 10.1016/s0168-8278(99)80173-1.


Background/aims: In patients with hepatocellular carcinoma, prediction of survival is difficult. The aim of this prospective study was to provide a simple classification for predicting survival of patients with hepatocellular carcinoma, based on a multivariable Cox model.

Methods: Seven hundred and sixty-one patients who presented with hepatocellular carcinoma from 24 Western medical centers were enrolled over a 30-month period. Patients were randomly assigned to either a training sample (n=506, with 418 deaths) from which a classification system was established, or a test sample (n=255, with 200 deaths) for validating its prognostic significance.

Results: Five prognostic factors were selected at the 0.0001 level: Karnofsky index <80% (relative risk of death=2.2, 95% confidence interval: 1.7-2.7), serum bilirubin >50 micromol/l (relative risk=2.1, 95% confidence interval: 1.7-2.6), serum alkaline phosphatase at least twice the upper limit of normal range (relative risk=1.6, 95% confidence interval: 1.3-2.0), serum alpha-fetoprotein >35 microg/l (relative risk=1.7, 95% confidence interval: 1.4-2.1), and ultrasonographic portal obstruction (relative risk=1.3, 95% confidence interval: 1.1-1.7). Three risk groups with different 1-year survival rates (72%, 34%, 7%) were derived, and independently validated in the test sample (79%, 31%, 4%).

Conclusion: This classification could be useful in the assessment of prognosis from homogeneous groups of patients with respect to their expected outcome.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Belgium
  • Canada
  • Carcinoma, Hepatocellular / classification*
  • Carcinoma, Hepatocellular / mortality*
  • Confidence Intervals
  • Female
  • France
  • Humans
  • Liver Neoplasms / classification*
  • Liver Neoplasms / mortality*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Time Factors