Barcelona Clinic Liver Cancer staging system and survival of untreated hepatocellular carcinoma in a hepatitis B virus endemic area. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Lee, Jeong‐Hoon; Kim, Hwi Young; Kim, Yoon Jun; Yoon, Jung‐Hwan; Chung, Jin Wook; Lee, Hyo‐Suk
• Is Part Of: Journal of gastroenterology and hepatology. Volume 30:Issue 4(2015:Apr.)
• Page Start: 696
• Page End: 705
• Publication Date: 2015-04
• Subjects: hepatocellular carcinoma -- natural history -- overall survival -- staging system; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.12788
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: A uniform staging system for hepatocellular carcinoma (HCC) is needed. In this study, the discrimination abilities of HCC staging systems (American Joint Committee on Cancer [AJCC], Barcelona Clinic Liver Cancer [BCLC], Cancer of the Liver Italian Program, and Okuda stage) were compared during the course of untreated HCC. Methods: We included consecutive 80 patients diagnosed with HCC, but were not treated for HCC, at a single medical center in Korea. In addition, 177 treated patients matched by prognostic factors were included to evaluate the survival gain owing to locoregional treatment. Results: The mean age of untreated patients was 58.7 years. During the observation period (median = 41.1 months), 72 patients died (median survival = 2.1 months; range = 1.6–33.7 months). Among various staging systems, the BCLC system had the best discrimination ability (linear trend χ 2 = 16.35). Multivariate analysis indicated that the intrahepatic tumor classification (AJCC T classification) was an independent predictor of overall survival (OS) ( P = 0.001). However, either node or metastasis classification failed to affect the OS significantly (both P > 0.05). Patients undergoing intrahepatic tumor control with locoregional therapy showed prolonged survival in those patients with nodal involvement (hazard ratio = 0.315; P = 0.004) and extrahepatic metastasis (hazard ratio = 0.658; P = 0.258), respectively, after adjustment for independent prognostic factors. Compared with untreated patients, BCLC stage A and B patients had > 1 year of survival gain but those with stage C and D did not, owing to locoregional therapy. Conclusion: The BCLC system had the best discrimination among untreated HCC patients. However, re‐evaluation of the clinical importance of nodal and metastasis classification might be required.