A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status
Gut and Liver
;
: 557-568, 2019.
Article
in English
| WPRIM
| ID: wpr-763870
ABSTRACT
BACKGROUND/AIMS:
Barcelona Clinic Liver Cancer (BCLC) C stage demonstrates considerable heterogeneity because it includes patients with either symptomatic tumors (performance status [PS], 1–2) or with an invasive tumoral pattern reflected by the presence of vascular invasion (VI) or extrahepatic spread (EHS). This study aimed to derive a more relevant staging system by modification of the BCLC system considering the prognostic implication of PS.METHODS:
A total of 7,501 subjects who were registered in the Korean multicenter hepatocellular carcinoma (HCC) registry database from 2008 to 2013 were analyzed. The relative goodness-of-fit between staging systems was compared using the Akaike information criterion (AIC) and integrated area under the curve (IAUC). Three modified BCLC (m-BCLC) systems (#1, #2, and #3) were devised by reducing the role of PS.RESULTS:
As a result, the BCLC C stage, which includes patients with PS 1–2 without VI/EHS, was reassigned to stage 0, A, or B according to their tumor burden in the m-BCLC #2 model. This model was identified as the most explanatory and desirable model for HCC staging by demonstrating the smallest AIC (AIC=70,088.01) and the largest IAUC (IAUC=0.722), while the original BCLC showed the largest AIC (AIC=70,697.17) and the smallest IAUC (IAUC=0.705). The m-BCLC #2 stage C was further subclassified into C1, C2, C3, and C4 according to the Child-Pugh score, PS, presence of EHS, and tumor extent. The C1 to C4 subgroups showed significantly different overall survival distribution between groups (p<0.001).CONCLUSIONS:
An accurate and relevant staging system for patients with HCC was derived though modification of the BCLC system based on PS.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Population Characteristics
/
Carcinoma, Hepatocellular
/
Tumor Burden
/
Liver
/
Liver Neoplasms
Type of study:
Controlled clinical trial
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
Gut and Liver
Year:
2019
Type:
Article
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