Journal of Vascular and Interventional Radiology
Volume 18, Issue 3 , Page 455, March 2007

Re: Prognostic Accuracy of 12 Liver Staging Systems in Patients with Unresectable Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Department of Radiology, Seoul Veterans Hospital, 6-2 Dunchon-dong, Gangdong-gu, Seoul 134-060, Korea

Article Outline

 

Editor:

In the October 2006 issue of JVIR, Georgiades et al (1) reported the comparative analysis of 12 liver staging systems. The authors evaluated 12 different staging systems based on the error reduction rate in predicting survival. I agree that error reduction rate can be a good measure of the discrimination ability of the systems.

I would, however, like to comment about some points made in the article. First, the monotonicity of the gradients for each staging system should have been also discussed (2). The mean survival time for a group classified as favorable with any system should be longer than the survival times noted in less favorable groups (2). Second, the 5th edition of the American Joint Committee on Cancer TNM staging manual, not the 6th edition (3), was used in the study. The 6th edition is the most recent TNM staging system and was reported to be more effective than that in the 5th edition (4). Third, in the statistical analysis, I think that there is some fault in the following equation for the estimated error reduction with various staging systems:

I think that the above-mentioned n should denote the number of stratification levels instead of the total number of patients, as was mentioned in the text. When the number of the stratification level becomes 1, the above-mentioned equation should become identical to the following equation for the estimated error reduction without the staging system, as it is:
This means that the n should denote the number of stratification levels.

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References 

  1. Georgiades CS, Liapi E, Frangakis C, et al. Prognostic accuracy of 12 liver staging systems in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization. J Vasc Interv Radiol. 2006;17:1619–1624
  2. Ueno S, Tanabe G, Sako K, et al. Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Hepatology. 2001;34:529–534
  3. Vauthey J, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol. 2002;20:1527–1536
  4. Varotti G, Ramacciato G, Ercolani G, et al. Comparison between the fifth and sixth editions of the AJCC/UICC TNM staging systems for hepatocellular carcinoma: multicentric study on 393 cirrhotic resected patients. Eur J Surg Oncol. 2005;31:760–767

PII: S1051-0443(07)00025-5

doi:10.1016/j.jvir.2006.12.738

Refers to article:

  • Drs Georgiades and Geschwind respond

    Christos S. Georgiades, Jean-Francois Geschwind
    Journal of Vascular and Interventional Radiology March 2007 (Vol. 18, Issue 3, Pages 456-457)

Journal of Vascular and Interventional Radiology
Volume 18, Issue 3 , Page 455, March 2007

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