Validation of the 7th Edition TNM Staging System for Hepatocellular Carcinoma: An Analysis of 8,828 Patients in a Single Medical Center

Major modification of the 7th tumor-node-metastasis (TNM) staging system for hepatocellular carcinoma (HCC) was divided into 6th stage IIIA to 7th IIIA (multiple tumors, any >5 cm) and IIIB (tumors involving a major vessel). This study aimed to validate 6th and 7th TNM systems in prognostic prediction, then analyze the impact of time, Child-Pugh classification and treatment modalities in survival. A total of 5,611 and 3,217 HCC patients were enrolled between 1986–2002 (past period) and 2003–2010 (recent period), respectively. The Akaike information criteria (AIC) within a Cox proportional hazard regression model were used to demonstrate the discriminatory ability for staging systems. The 1-, 3-, and 5-year survival rates of past and recent periods were 44.8, 24.9, 17.1 %, and 65.5, 44.5, 34.6 %, respectively (p