J Cancer 2015; 6(4):394-402. doi:10.7150/jca.11212

Research Paper

Clinical Implication of Performance Status in Patients with Hepatocellular Carcinoma Complicating with Cirrhosis

Hiroki Nishikawa1,✉, Ryuichi Kita1, Toru Kimura1, Yoshiaki Ohara1, Azusa Sakamoto1, Sumio Saito1, Norihiro Nishijima1, Akihiro Nasu1, Hideyuki Komekado1, Yukio Osaki1

1Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan

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Nishikawa H, Kita R, Kimura T, Ohara Y, Sakamoto A, Saito S, Nishijima N, Nasu A, Komekado H, Osaki Y. Clinical Implication of Performance Status in Patients with Hepatocellular Carcinoma Complicating with Cirrhosis. J Cancer 2015; 6(4):394-402. doi:10.7150/jca.11212. Available from http://www.jcancer.org/v06p0394.htm

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Background and aims: The aims of our study were to elucidate the relationship between baseline characteristics of hepatocellular carcinoma (HCC) patients complicating with liver cirrhosis (LC) and performance status (PS) and to investigate the impact of PS on survival in patients with HCC complicating with LC.

Methods: In a total of 1003 patients diagnosed with HCC complicating with LC, we divided into two groups of PS ≥1 (n=251) and PS 0 (n=752) as evaluated by using the Eastern Cooperative Oncology Group criteria at the time of HCC diagnosis. Baseline characteristics between these two groups were compared. We also performed univariate and multivariate analyses of factors contributing to overall survival (OS).

Results: The median follow-up period was 1.6 years in the PS ≥1 group and 3.1 years in the PS 0 group. The 1-, 3- and 5-year OS rates after each initial therapy for HCC were 90.3%, 67.4% and 49.8%, respectively, in the PS 0 group and 73.4%, 42.0% and 17.7%, respectively, in the PS ≥1 group (P<0.001). A worse PS was significantly associated with age, gender, Child-Pugh classification, HCC stage, Japan Integrated Staging score, initial treatment option for HCC, maximum tumor size, alanine aminotransferase value, hypoalbuminemia, hyperbilirubinemia, renal insufficiency, hyponatremia, prothrombin time prolongation, platelet count and tumor marker level. In multivariate analyses, poorer PS was an independent predictor linked to OS with a hazard ratio of 1.773 (P<0.001).

Conclusions: PS was closely associated with status of HCC patients with LC and could be an important predictor for these populations.

Keywords: Hepatocellular carcinoma, Liver cirrhosis, Performance status, Prognostic factor, Propensity score matching