Evaluation of the predictive accuracy of nine staging systems in patients with hepatocellular carcinoma: a multicenter, retrospective study in China

There are several staging systems for hepatocellular carcinoma (HCC); however, the best prognostic system for Chinese patients has not been established. The aim of this study was to evaluate nine staging systems and identify the best prognostic staging system for Chinese patients with HCC. This retrospective study included 1,495 patients with HCC from 2012 to 2022 in 17 hospitals in China. The predictive ability of nine HCC staging systems was evaluated based on homogeneity, monotonicity of gradients, Akaike’s information criterion, and area under the receiver operating characteristic curve. Overall survival at 1, 3 and 5 years was 59.90%, 40.34%, and 34.83%, respectively. Multivariable Cox analysis identified older age, multiple tumor nodules, maximum tumor size > 5 cm, macrovascular invasion, distant metastases, treatment modalities, worse performance status, low protein, high bilirubin, and high alpha-fetoprotein as independent prognostic factors. The Hong Kong Liver Cancer (HKLC) system showed the highest predictive accuracy for Chinese patients in hepatitis B virus-infected populations and in those undergoing non-curative treatment. The Cancer of the Liver Italian Program showed the best predictive ability in patients with hepatitis C virus infection or in the curative treatment subgroup. HKLC may be the most consistent and reliable prognostic model for patients with HCC in the Chinese population.