741P - Validation of prognostic value of AJCC 7th staging system in patients with resected hepatocellular carcinoma (HCC)

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Hepatobiliary Cancers
Staging Procedures (clinical staging)
Basic Principles in the Management and Treatment (of cancer)
Presenter Soo Fan Ang
Authors S.F. Ang1, H. Li2, S. Choo3, I.B. Tan4, M.H. Tan3, H.C. Toh5
  • 1Medical Oncology, NATIONAL CANCER CENTER SINGAPORE, 169610 - Singapore/SG
  • 2Department Of Clinical Research, Singapore General Hospital, Singapore/SG
  • 3Medical Onocology, NATIONAL CANCER CENTER SINGAPORE, 169610 - Singapore/SG
  • 4Dept. Medical Oncology, National Cancer Centre, 169610 - Singapore/SG
  • 5Medical Oncology, National Cancer Centre Singapore, Singapore/SG



Accurate cancer staging is essential to determine prognosis and appropriate treatment. The American Joint Committee on Cancer (AJCC) Staging Manual 7th edition for HCC released in 2010 subdivided stage III HCC to IIIA (multiple tumors of which any are greater than five centimeters, but lack major vessel invasion, T3A) and IIIB (invasion of major vessels, T3B). Both were previously classified as stage IIIA in the AJCC 6th. T4N0M0 and patients with node-positive disease (N1) are upstaged to stage IIIC and IVA respectively. The aim of our study is validate the revised AJCC 7th staging system based on outcomes of patients undergoing liver resection for HCC from a single institution.


Records for all patients undergoing potentially curative surgery for localized HCC between 1992 – 2007 were retrospectively reviewed. Pathological staging were determined post-operatively. Survival curves were plotted with the Kaplan–Meier method and were compared by using a log-rank test for various disease stages based on AJCC 7th staging system.


543 patients were included (439 male) and 80% were Chinese ethnicity. 303 patients were chronic hepatitis B carriers. The median follow up was 1.78 years with 282 relapsed patients (51.9%) and 189 deaths (34.8%). Median survival (MS) and time-to-relapse (TTR) were 4.83 years and 2.00 years respectively. MS for AJCC 7 stage I, II, III and IV were 6.35, 4.44, 2.41 and 0.49 years respectively (p <0.0001). MS and TTP for AJCC 7th Stage IIIA (n = 56) and IIIB (n = 33) were however not significantly different [MS 2.74 vs 2.41 years, HR 1.11 (95% CI 0.56, 2.18); TTR 0.83 vs 0.48 years, HR 1.36 (95% CI 0.80, 2.32)].


The revised AJCC 7th TNM staging system has prognostic significance and predicts OS and TTP in resected HCC patients. However subdividing HCC into Stage IIIA and IIIB showed no significant difference in prognosis.


All authors have declared no conflicts of interest.