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The recommended treatment algorithms of the BCLC and HKLC staging systems: does following these always improve survival rates for HCC patients?
Author(s) -
Kim Kwang Min,
Sinn Dong Hyun,
Jung SinHo,
Gwak GeumYoun,
Paik YongHan,
Choi Moon Seok,
Lee Joon Hyeok,
Koh Kwang Cheol,
Paik Seung Woon
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13107
Subject(s) - hepatocellular carcinoma , liver cancer , medicine , stage (stratigraphy) , staging system , gastroenterology , cancer , oncology , biology , paleontology
Background & Aims Several staging systems have been proposed for hepatocellular carcinoma ( HCC ). Among them, only the Barcelona Clinic Liver Cancer ( BCLC ) and Hong Kong Liver Cancer ( HKLC ) staging systems also recommend treatment modality. This study was designed to see whether BCLC and HKLC staging can guide treatment strategy, so analyzed whether patients survival is better for those who received recommended therapy by each staging system. Methods A total of 3515 treatment‐naïve, newly diagnosed HCC patients at a single centre were analyzed. Results Five‐year survival rates according to BCLC stages: 0 = 79.1%, A = 62.9%, B = 40.3%, C = 21.3% and D = 27.0%; 5‐year survival rates according to HKLC stages: I = 72.3%, II a = 54.9%, II b = 50.6%, III a = 21.3%, III b = 10.2%, IV a = 16.7%, IV b = 7.2%, Va = 47.1% and Vb = 11.3%. The C‐indices of the BCLC and HKLC staging systems were 0.708 and 0.732 respectively. Patient survival was better when patients received the recommended treatment in stages 0 or A; survival was worse if treatment began at stage B, C or D. For HKLC staging system, survival was better when patients received the recommended treatment in stages I, II a, II b, III a or Va but was worse when treatment began in stages III b, IV a, IV b or Vb. Conclusion Both the BCLC and HKLC staging systems effectively stratified patient prognosis, but neither could direct therapy for a large proportion of patients; for some stages, recommended therapy was associated with worse prognosis.