Comparing ECOG-PS and Charlson Comorbidity Index for stratification of hepatocellular carcinoma prognosis across treatments.
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Famularo Simone, Milana Flavio, Vitale Alessandro, Serenari Matteo, Bruccoleri Mariangela, Stefanini Bernardo, Biasini Elisabetta, Celsa Ciro, Campani Claudia, Pinto Elisa, Secomani Alice, Arru Marco, Ardito Francesco, Ghittoni Giorgia, Fontana Andrea, Nicolini Daniele, Cacciola Irene, Montori Michele, Dajti Elton, Inno Alessandro, Matthaeis Nicoletta, Guarino Maria, Marzi Luca, Damone Francesco, Iaria Maurizio, Lauterio Andrea, Garancini Mattia, Pasta Andrea, Zanello Matteo, Cicerone Ottavia, Conci Simone, Lai Quirino, Facciorusso Antonio, De Peppo Valerio, Molfino Sarah, Rocco Alba, Conticchio Maria, Pozzi Eleonora, Ferrari Cecilia, Romano Maurizio, Patrone Renato, Germani Paola, Patauner Stefan, Zimmitti Giuseppe, Bonfiglioli Andrea, Troci Albert, Malagnino Alessia, De Angelis Michela, Boccia Luigi, Zago Mauro, Lani Lorenzo, Caraceni Paolo, Crespi Michele, Magalotti Donatella, Frena Antonio, Tarchi Paola, Izzo Francesco, Zanus Giacomo, Griseri Guido, Ercolani Giorgio, Memeo Riccardo, Nardone Gerardo, Baiocchi Gian Luca, Perri Pasquale, Grazi Gian Luca, Sacco Rodolfo, Rossi Massimo, Ruzzenente Andrea, Maestri Marcello, Jovine Elio, Romano Fabrizio, De Carlis Luciano, Dalla Valle Raffaele, Brunetto Maurizia Rossana, Mega Andrea, Morisco Filomena, Ponziani Francesca Romana, Boninsegna Sara, Azzaroli Francesco, Baroni Gianluca Svegliati, Saitta Carlo, Vivarelli Marco, Ferrero Alessandro, Caturelli Eugenio, Vidili Gianpaolo, Foschi Francesco Giuseppe, Russo Frncesco Paolo, Marra Fabio, Cabibbo Giuseppe, Missale Gabriele, Tovoli Francesco, Sangiovanni Angelo, Cescon Matteo, Cillo Umberto, Torzilli Guido, Trevisani Franco, Giuliante Felice, Giannini Edoardo G, HE.RC.O.LE.S. and ITA.LI.CA. Groups
Аннотация
METHODS: Data were collected from patients enrolled in two Italian HCC databases, ITA.LI.CA and HE.RC.O.LE.S., between 2009 and 2023. Treatments were stratified as follows: liver resection, ablation, embolization, systemic therapy, and liver transplantation (OLT). The association of ECOG-PS and CCI with overall survival (OS) was assessed using Cox regression, concordance index (C-index), and Akaike information criterion (AIC), with internal validation via bootstrapping.
RESULTS: Among 4606 resected patients, CCI (HR 1.10, 95%CI: 1.06-1.14, p < 0.001) was independently associated with OS, while ECOG-PS was not (HR 0.92, 95%CI: 0.79-1.09, p = 0.340). In 1797 patients treated with ablation, both ECOG-PS (HR 1.29, 95%CI: 1.08-1.54, p = 0.006) and CCI (HR 1.11, 95%CI: 1.05-1.17, p < 0.001) were independently associated with OS. For 1531 embolized patients and 457 on systemic therapy, only ECOG-PS remained independently associated with OS (HR 1.38, 95%CI: 1.18-1.62, and HR 1.48, 95%CI: 1.18-1.86, respectively, both p < 0.01). In 108 OLT patients, neither score was associated with OS. CCI showed slightly higher discrimination in curative settings, whereas ECOG-PS showed higher discrimination in palliative settings.
CONCLUSION: The prognostic relevance of ECOG-PS and CCI varies across HCC treatment modalities. CCI showed a more consistent prognostic association in curative settings, whereas ECOG-PS was more informative in palliative contexts. Neither score showed strong standalone discrimination, supporting their interpretation as complementary measures of patient vulnerability.