Is the pathologic TNM staging system for patients with hepatoma predictiveof outcome?

BACKGROUND. The pathologic TNM (pTNM) staging system was designed to aid in determining the prognosis of cancer patients and in planning and evaluatin g their treatment. The current pTNM classification system was not found to be predictive for patients undergoing orthotopic liver transplantation (OLT x) in the presence of hepatocellular carcinoma (HCC). Therefore, the author s examined the current system to determine whether improvements would allow the development of a more predictive system. METHODS. Three hundred seven patients with HCC underwent OLTx between 1981 and 1997. Risk factors for recurrence were identified using the Kaplan-Meie r method with the log rank test. The Cox proportional hazards model was use d to identify factors independently predictive of recurrence which were the n used to create a new staging system. RESULTS. There was neither a direct correlation between the current pTNM sy stem and tumor free survival nor homogeneity in outcomes for patients withi n certain current pTNM categories. Depth of vascular invasion, lobar distri bution, lymph node status, and largest tumor size were found to be independ ent predictors of tumor free survival; tumor number was not found to be sig nificant in multivariate analysis. A new staging system is proposed, which takes into account the results of the multivariate analysis in which tumor free survival correlates directly with stage. CONCLUSIONS. The proposed staging system is superior to the current pTNM st aging system in predicting tumor free survival following OLTx with HCC. Fur ther studies will determine the appropriateness of this system for staging HCC after subtotal hepatic resection. (C) 2000 American Cancer Society.