Cancer Res Treat.  2020 Oct;52(4):1145-1152. 10.4143/crt.2020.208.

Evaluation of the American Joint Committee on Cancer (AJCC) 8th Edition Staging System for Hepatocellular Carcinoma in 1,008 Patients with Curative Resection

• Park S
• Choi S
• Cho YA
• Sinn DH
• Kim JM
• Park CK
• Ha SY

• KMID: 2507940
• DOI: http://doi.org/10.4143/crt.2020.208

Abstract

Purpose
Recently, the 8th edition staging system of the American Joint Committee on Cancer (AJCC) for hepatocellular carcinoma (HCC) was released, including a change in T category. We aimed to validate the new AJCC system.
Materials and Methods
The predictive value of the new AJCC was validated in comparison to the previous edition, in a total 1,008 patients who underwent curative resection for HCC as initial treatment.
Results
The 2-year area under the curve values for recurrence-free survival (RFS) and overall survival (OS) were comparable in the 7th and 8th editions. Stage migration was observed in 63 patients (6.3%); from T2 to T1a for 44 patients and from T3 to T4 for 19 patients. The RFS and OS were not different between T1a and T1b in the 8th edition. For solitary tumors ≤ 2 cm, those with microvascular invasion had lower RFS and OS values than those without although they were all classified as T1a in the 8th edition. Tumors involving a major branch of the portal or hepatic vein (T4 by the 8th edition and T3b by the 7th edition) had shorter RFS and OS than multifocal tumors, at least one of which was > 5 cm (T3 by the 8th edition and T3a by the 7th edition).
Conclusion
The AJCC 8th edition staging system for HCC showed comparable predictive performance to the 7th edition. It is desirable in a future revision to consider sub-stratification of solitary tumors ≤ 2 cm (T1a) depending on the presence of vascular invasion, which is not included in the 8th edition.

Keyword

Hepatocellular carcinoma; Stage; Prognosis; Microvascular invasion

Figure

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  Fig. 1. Summary of patient selection. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; RFA, radiofrequency ablation.

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  Fig. 2. Kaplan-Meir survival curves according to the American Joint Committee on Cancer T category of the 7th edition: recurrence-free survival (A) and overall survival (B).

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  Fig. 3. Kaplan-Meir survival curves according to the American Joint Committee on Cancer T category of the 8th edition: recurrence-free survival (A) and overall survival (B).

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  Fig. 4. The area under the curve graphs for recurrence (A) and death (B) by the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) T category.

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  Fig. 5. Kaplan-Meir survival curves of single hepatocellular carcinoma ≤ 2 cm according to presence of microvascular invasion: recurrence-free survival (A) and overall survival (B).

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  Fig. 6. Kaplan-Meir survival curves of the American Joint Committee on Cancer T category 3a versus 3b of the 7th edition: recurrence-free survival (A) and overall survival (B).

Reference

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