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
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/174384 |
| Date | January 2012 |
| Creators | Tang, Yuen-fong., 鄧婉芳. |
| Contributors | Yao, TJ, Poon, RTP, Yau, TCC |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B47324089 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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