Evaluation of the Outcome after Transarterial Chemoembolization; Refinement of Barcelona Clinic Liver Cancer Stage-B from Eastern Point of View

ABSTRACT

Transarterial chemoembolization (TACE) is recommended as the first line treatment option for the patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), however, treatment strategy and evaluation of effects after TACE has not been fully established. Recently, sub-stage of BCLC stage B has been proposed and validated, but it should be validated including a large number of the patients and its refinement should be discussed. We have validated the sub-stage of BCLC stage B (B1-B4) by comparing overall survival after TACE, and there was no statistically significant difference in overall survival after TACE between B1 and B2. After excluding the patients with Child-Pugh point 7 from B1, the overall survival was significantly better than that of B2. Therefore, up-to-seven criteria is shown to be a reliable tool for the treatment strategy in the patients with intermediate stage of HCC. Refinement of sub-stage of BCLC stage B has been proposed by some other institutes, and it is important to establish novel treatment strategy for the patients with BCLC stage B after TACE to improve the prognosis of the patients after TACE, and to define the best timing for conversion to sorafenib or liver transplantation should be discussed.