[Evaluation of new TNM staging system for hepatocellular carcinoma after hepatectomy].

BACKGROUND & OBJECTIVE: The TNM staging system for hepatocellular carcinoma (HCC) was revised by the International Union Against Cancer (UICC) from the 5th edition (TNM5) to the 6th edition (TNM6) in 2002. This study was to evaluate the prognostic value of TNM6 staging in a large cohort study of HCC patients who underwent hepatectomy, and investigate its feasibility and applicability in China.

METHODS: Clinical and follow-up data of 478 HCC patients, who underwent hepatectomy in our center from Jan. 1993 to Dec. 1998, were reviewed retrospectively. Survival rates of the patients were compared according to TNM5 staging and TNM6 staging. The advantages and disadvantages of TNM6 staging were analyzed.

RESULTS: According to TNM5 staging, 12 (2.5%) patients were in stage I, 224 (46.8%) in stage II, 95 (19.9%) in stage IIIA, 8 (1.7%) in stage IIIB, and 139 (29.1%) in stage IVA. The 5-year survival rates were 81.8%, 41.5%, 17.0%, 0%, and 10.2%, respectively; there were significant differences in survival rate between stage II and IIIA, between stage II and IIIB, and between stage IIIA and IIIB, but no significant differences were observed between stage I and II, or between stage IIIB and IVA. According to TNM6 staging, 234 (48.9%) patients were in stage I, 41 (8.6%) in stage II, 96 (20.1%) in stage IIIA, 88 (18.4%) in stage IIIB, and 19 (4.0%) in stage IIIC. The 5-year survival rates were 43.3%, 20.2%, 13.1%, 13.0%, and 0, respectively; there was significant difference in survival rate between stage I and II, but no significant differences were found between stage II and IIIA, between stage II and IIIB, and between stage IIIA and IIIB.

CONCLUSIONS: TNM6 staging has important improvement, and is simpler than TNM5 staging. But TNM6 staging still has limitation, which is not very accurate to predict the prognosis in clinical practice, and is not suitable for Chinese HCC patients who were usually accompanied with cirrhosis.