published_or_final_version / Public Health / Master / Master of Public Health

There are a number of existing staging systems for patients with hepatocellular carcinoma (HCC). Yet, Barcelona Clinic Liver Cancer (BCLC) staging classification is the only one which suggests treatment guidance. Although BCLC staging is widely used in Western countries, it may not fit in the management of HCC patients in Hong Kong as they mostly have different etiologies and have more aggressive treatment strategy when compared with their counterparts in Western countries. It is aimed in this thesis to develop a new prognostic staging system in conjunction with treatment guidelines for HCC patients in Hong Kong. Three thousand eight hundred and fifty six adult HCC patients presented to the Department of Surgery, Queen Mary Hospital between January 1995 and December 2008 were included. The patient data were randomly separated into a training set and a test set for scheme development and performance assessment respectively. Four established prognostic factors which have determinative roles in treatment, namely Eastern Cooperative Oncology Group performance status, Child-Pugh grade, tumor status, and presence of extrahepatic vascular invasion/metastasis, were selected in building the scheme. Cox proportional hazards regression on overall survival was used to derive a relative coefficient for each category of these four factors. Clinical knowledge in addition to the relative coefficients was involved in the proposal of the prognostic stages. Then a classification and regression tree analysis was performed to elicit a set of simple clinical decision rules given the factors. This tree-structured classifier was adjusted with clinical judgment and reconciled with the proposed prognostic staging system for treatment guidelines. This Hong Kong Combined Liver Cancer (HKCLC) prognostic classification scheme stratifies patients to stages I to V with distinct overall survival outcomes. Its performance was compared to BCLC scheme for their discriminatory ability as staging systems and effectiveness of treatment guidelines. The former used receiver operating characteristics (ROC) analysis and concordance index as measures of the ability to distinguish patients with different prognosis for overall survival. HKCLC staging had significantly larger 1-year, 3-year and 5-year area under ROC curve values and higher concordance index vis-a-vis BCLC staging. The latter compared the overall survival of patients who received different treatments. The overall survival of patients with the same BCLC stage and the same HKCLC stage but received HKCLC recommended treatments were compared with those received BCLC recommended treatments by Kaplan-Meier plots and log-rank test. HKCLC treatment guidelines had wider indications for more aggressive treatments than the BCLC treatment schedule, and demonstrated significant survival benefit in our patients. / published_or_final_version / Surgery / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / abstract / toc / Community Medicine / Doctoral / Doctor of Philosophy

University of Macau / Institute of Chinese Medical Sciences