Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: Single centre experience from long-term clinical outcomes of 1717 treatment-naïve patients with hepatocellular carcinoma

Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Mi Sung Park, Eun Hye Kim, Jinsil Seong, Do Youn Lee, Kwang Hyub Han

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Abstract

Background: The most informative staging system regarding survival outcomes for treatment-naïve hepatocellular carcinoma (HCC) remains debated. We evaluated prognostic values of Barcelona Clinic Liver Cancer (BCLC) stage compared with other staging systems, and identified discrepancies between treatment options chosen in Korean clinical practice and BCLC guidelines. Methods: Between 2003 and 2008, 1717 prospectively enrolled patients with treatment-naïve HCC were analysed. Prognostic ability of each staging system was assessed using time-dependent receiver-operating characteristic (ROC) curves. Results: The most common aetiology was hepatitis B virus (1238, 72.1%); 167 (9.8%) patients were classified as BCLC stage 0, 526 (30.6%) as A, 333 (19.4%) as B, 608 (35.4%) as C and 83 (4.8%) as D. Median overall survival was 22.5 months, and 1-, 2-, 3-, 4-, and 5-year survival rates were 62.6, 48.3, 39.9, 34.7, and 29.3% respectively. Of six staging systems, BCLC had the highest area under ROC (AUROC; 0.821) for overall survival, followed by JIS (0.809), Tokyo score (0.771), CLIP (0.746), CUPI (0.701) and GRETCH (0.685) system. In both subgroups stratified according to treatment strategy (curative vs. palliative), BCLC also showed the best AUROCs (curative, 0.708/palliative, 0.807) for overall survival. Regarding discrepancies between treatment options chosen in our cohort and BCLC guidelines, more than half with very early/early-stage HCC underwent transarterial chemoembolization, rather than resection or local ablative therapy; most of those with advanced-stage HCC received intra-arterial chemotherapy-based treatments rather than sorafenib. Conclusion: BCLC was the best long-term prognostic model for treatment-naïve HCC in a large-scale Korean cohort. However, treatment modalities did not exactly match BCLC paradigm.

Original languageEnglish
Pages (from-to)1120-1127
Number of pages8
JournalLiver International
Volume32
Issue number7
DOIs
Publication statusPublished - 2012 Aug 1

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Liver Neoplasms
Hepatocellular Carcinoma
Survival
Therapeutics
ROC Curve
Guidelines
Tokyo
Hepatitis B virus
Survival Rate
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

@article{2f27a2eaf7954709abb04fa1bdc62f38,
title = "Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: Single centre experience from long-term clinical outcomes of 1717 treatment-na{\"i}ve patients with hepatocellular carcinoma",
abstract = "Background: The most informative staging system regarding survival outcomes for treatment-na{\"i}ve hepatocellular carcinoma (HCC) remains debated. We evaluated prognostic values of Barcelona Clinic Liver Cancer (BCLC) stage compared with other staging systems, and identified discrepancies between treatment options chosen in Korean clinical practice and BCLC guidelines. Methods: Between 2003 and 2008, 1717 prospectively enrolled patients with treatment-na{\"i}ve HCC were analysed. Prognostic ability of each staging system was assessed using time-dependent receiver-operating characteristic (ROC) curves. Results: The most common aetiology was hepatitis B virus (1238, 72.1{\%}); 167 (9.8{\%}) patients were classified as BCLC stage 0, 526 (30.6{\%}) as A, 333 (19.4{\%}) as B, 608 (35.4{\%}) as C and 83 (4.8{\%}) as D. Median overall survival was 22.5 months, and 1-, 2-, 3-, 4-, and 5-year survival rates were 62.6, 48.3, 39.9, 34.7, and 29.3{\%} respectively. Of six staging systems, BCLC had the highest area under ROC (AUROC; 0.821) for overall survival, followed by JIS (0.809), Tokyo score (0.771), CLIP (0.746), CUPI (0.701) and GRETCH (0.685) system. In both subgroups stratified according to treatment strategy (curative vs. palliative), BCLC also showed the best AUROCs (curative, 0.708/palliative, 0.807) for overall survival. Regarding discrepancies between treatment options chosen in our cohort and BCLC guidelines, more than half with very early/early-stage HCC underwent transarterial chemoembolization, rather than resection or local ablative therapy; most of those with advanced-stage HCC received intra-arterial chemotherapy-based treatments rather than sorafenib. Conclusion: BCLC was the best long-term prognostic model for treatment-na{\"i}ve HCC in a large-scale Korean cohort. However, treatment modalities did not exactly match BCLC paradigm.",
author = "Kim, {Beom Kyung} and Kim, {Seung Up} and Park, {Jun Yong} and Kim, {Do Young} and Ahn, {Sang Hoon} and Park, {Mi Sung} and Kim, {Eun Hye} and Jinsil Seong and Lee, {Do Youn} and Han, {Kwang Hyub}",
year = "2012",
month = "8",
day = "1",
doi = "10.1111/j.1478-3231.2012.02811.x",
language = "English",
volume = "32",
pages = "1120--1127",
journal = "Liver International",
issn = "1478-3223",
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TY - JOUR

T1 - Applicability of BCLC stage for prognostic stratification in comparison with other staging systems

T2 - Single centre experience from long-term clinical outcomes of 1717 treatment-naïve patients with hepatocellular carcinoma

AU - Kim, Beom Kyung

AU - Kim, Seung Up

AU - Park, Jun Yong

AU - Kim, Do Young

AU - Ahn, Sang Hoon

AU - Park, Mi Sung

AU - Kim, Eun Hye

AU - Seong, Jinsil

AU - Lee, Do Youn

AU - Han, Kwang Hyub

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Background: The most informative staging system regarding survival outcomes for treatment-naïve hepatocellular carcinoma (HCC) remains debated. We evaluated prognostic values of Barcelona Clinic Liver Cancer (BCLC) stage compared with other staging systems, and identified discrepancies between treatment options chosen in Korean clinical practice and BCLC guidelines. Methods: Between 2003 and 2008, 1717 prospectively enrolled patients with treatment-naïve HCC were analysed. Prognostic ability of each staging system was assessed using time-dependent receiver-operating characteristic (ROC) curves. Results: The most common aetiology was hepatitis B virus (1238, 72.1%); 167 (9.8%) patients were classified as BCLC stage 0, 526 (30.6%) as A, 333 (19.4%) as B, 608 (35.4%) as C and 83 (4.8%) as D. Median overall survival was 22.5 months, and 1-, 2-, 3-, 4-, and 5-year survival rates were 62.6, 48.3, 39.9, 34.7, and 29.3% respectively. Of six staging systems, BCLC had the highest area under ROC (AUROC; 0.821) for overall survival, followed by JIS (0.809), Tokyo score (0.771), CLIP (0.746), CUPI (0.701) and GRETCH (0.685) system. In both subgroups stratified according to treatment strategy (curative vs. palliative), BCLC also showed the best AUROCs (curative, 0.708/palliative, 0.807) for overall survival. Regarding discrepancies between treatment options chosen in our cohort and BCLC guidelines, more than half with very early/early-stage HCC underwent transarterial chemoembolization, rather than resection or local ablative therapy; most of those with advanced-stage HCC received intra-arterial chemotherapy-based treatments rather than sorafenib. Conclusion: BCLC was the best long-term prognostic model for treatment-naïve HCC in a large-scale Korean cohort. However, treatment modalities did not exactly match BCLC paradigm.

AB - Background: The most informative staging system regarding survival outcomes for treatment-naïve hepatocellular carcinoma (HCC) remains debated. We evaluated prognostic values of Barcelona Clinic Liver Cancer (BCLC) stage compared with other staging systems, and identified discrepancies between treatment options chosen in Korean clinical practice and BCLC guidelines. Methods: Between 2003 and 2008, 1717 prospectively enrolled patients with treatment-naïve HCC were analysed. Prognostic ability of each staging system was assessed using time-dependent receiver-operating characteristic (ROC) curves. Results: The most common aetiology was hepatitis B virus (1238, 72.1%); 167 (9.8%) patients were classified as BCLC stage 0, 526 (30.6%) as A, 333 (19.4%) as B, 608 (35.4%) as C and 83 (4.8%) as D. Median overall survival was 22.5 months, and 1-, 2-, 3-, 4-, and 5-year survival rates were 62.6, 48.3, 39.9, 34.7, and 29.3% respectively. Of six staging systems, BCLC had the highest area under ROC (AUROC; 0.821) for overall survival, followed by JIS (0.809), Tokyo score (0.771), CLIP (0.746), CUPI (0.701) and GRETCH (0.685) system. In both subgroups stratified according to treatment strategy (curative vs. palliative), BCLC also showed the best AUROCs (curative, 0.708/palliative, 0.807) for overall survival. Regarding discrepancies between treatment options chosen in our cohort and BCLC guidelines, more than half with very early/early-stage HCC underwent transarterial chemoembolization, rather than resection or local ablative therapy; most of those with advanced-stage HCC received intra-arterial chemotherapy-based treatments rather than sorafenib. Conclusion: BCLC was the best long-term prognostic model for treatment-naïve HCC in a large-scale Korean cohort. However, treatment modalities did not exactly match BCLC paradigm.

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U2 - 10.1111/j.1478-3231.2012.02811.x

DO - 10.1111/j.1478-3231.2012.02811.x

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