Background: With aging and increasing comorbidities in the general population, the treatment of hepatocellular carcinoma (HCC) requires accurate prognostic assessment. This study aimed to compare the prognostic utility of the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Charlson Comorbidity Index (CCI) across different HCC therapeutic strategies. 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.
Famularo, S., Milana, F., Vitale, A., Serenari, M., Bruccoleri, M., Stefanini, B., et al. (2026). Comparing ECOG-PS and Charlson Comorbidity Index for stratification of hepatocellular carcinoma prognosis across treatments. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY, 52(12) [10.1016/j.ejso.2026.112135].
Comparing ECOG-PS and Charlson Comorbidity Index for stratification of hepatocellular carcinoma prognosis across treatments
Lauterio A.;Romano F.;De Carlis L.;
2026
Abstract
Background: With aging and increasing comorbidities in the general population, the treatment of hepatocellular carcinoma (HCC) requires accurate prognostic assessment. This study aimed to compare the prognostic utility of the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Charlson Comorbidity Index (CCI) across different HCC therapeutic strategies. 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.
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