Clinical and Molecular Hepatology

"Neoplasm staging"

Original Articles

Applicability of the BCLC staging system to patients with hepatocellular carcinoma in Korea: analysis at a single center with a liver transplant center: Sung Eun Kim, Han Chu Lee, Kang Mo Kim, Young-Suk Lim, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh; Korean J Hepatol 2011;17(2):113-119.
Published online June 23, 2011; DOI: https://doi.org/10.3350/kjhep.2011.17.2.113

Abstract
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Background/Aims

The Barcelona Clinic Liver Cancer (BCLC) staging system is logical for the staging and treatment of hepatocellular carcinoma (HCC) because it was based on survival data. This study evaluated the applicability of the BCLC staging system and reasons for divergence from BCLC-recommended treatments in Korean HCC patients.

Methods

One hundred and sixty consecutive HCC patients were prospectively enrolled. Treatments were generally recommended according to the guideline of the American Association for the Study of Liver Diseases, but patients were also informed about alternative treatments. The final decision was made with patient agreement, and was based on the doctor's preferences when a patient was unable to reach a decision.

Results

There were 2 (1%), 101 (64%), 20 (12.5%), 34 (21.5%), and 3 (1%) patients with very early-, early-, intermediate-, advanced-, and terminal-stage disease, respectively. Only 64 patients (40%) were treated according to BCLC recommendations. The treatment deviated from BCLC recommendations in 68% (69/101) and 79% (27/34) of patients with early and advanced stage, respectively. The main causes of deviation were refusal to undergo surgery, the presence of an indeterminate malignancy nodule, the absence of a suitable donor, or financial problems.

Conclusions

Donor shortage, financial problems, the relatively limited efficacy of molecular targeting agents, and the presence of an indeterminate nodule were the main causes of deviation from BCLC recommendations. Even after excluding cases in which decisions were made by patient preference, only 66% of the HCC patients were treated according to BCLC recommendations. Treatment guidelines that reflect the Korean situation are mandatory for HCC patients.

Citations

Citations to this article as recorded by

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Crossref

Treatment Outcome and Prognostic Factors in Patients with Advanced Hepatocellular Carcinoma (TNM Stage IVa) according to Anticancer drugs of Transhepatic Arterial Chemoinfusion: Sang Hoon Ahn, M.D., Kwang-Hyub Han, M.D., Young Hoon Youn, M.D.,Myoung Hwan Kim, M.D., Kun Hoon Song, M.D., Kwan Sik Lee, M. D., Chae Yoon Chon, M.D., Young Myoung Moon, M.D., Do Yun Lee, M.D.* and Jong Tae Lee, M.D.*; Korean J Hepatol 2000;6(4):456-467.

Abstract
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Background/Aims
The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. Methods: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). Results: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size(>5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. Conclusion: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.

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Modified CLIP Score as a New Prognostic Index for Patients with Hepatocellular Carcinoma: Seung Ho Han, M.D., Sang Young Han, M.D., Byoung Soung Go, M.D., Min Ji Kim, M.D., Jung Hyun Lee, M.D., Young Hun Koo, M.D., Seung Hoon Ryu, M.D., Jeong Hwan Cho, M.D., Jin Seok Jang, M.D., Jong Hoon Lee, M.D., Myung Hwan Roh, M.D., Seok Ryeol Choi, M.D., Joung Chel Choi, M.D.1, and Sung Wook Lee, M.D.; Korean J Hepatol 2006;12(2):209-220.

Abstract
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Backgrounds/Aims: The prognosis of cirrhotic patients with hepatocellular carcinoma (HCC) depends on both residual liver function and tumor characteristics. The aims of this study was to construct a new prognostic index for HCC patients: the modified CLIP score, and to compare its discriminatory ability and predictive power with those of the CLIP score that is currently the most commonly used integrated staging score in patients of HCC. Methods: A retrospective analysis of 237 cases of HCC diagnosed at Dong-A university hospital was performed. Prognostic analysis was performed for single variables by estimating survival distributions with the Kaplan-Meier’s method, and statistically compared by the log-rank test. Results: Patients had a mean age of 57.5 years and were predominantly males (79.7%). The overall median survival period was 25.7 months. It was correlated to ascites, portal vein thrombosis, AFP, tumor size, and Child-Pugh classification. The median survival period was 41.0, 25.2, 13.8, 13.4, and 6.5 months for CLIP scores 0, 1, 2, 3, and 4 to 6, respectively (P<0.001), and 42.1, 34.0, 25.7, 14.0, and 6.8 months for modified CLIP scores 0, 1, 2, 3, and 4 to 6, respectively (P<0.001). The Kaplan-Meier’s curve showed that the modified CLIP score had additional explanatory power above that of the CLIP score. Conclusions: The modified CLIP score, compared with the CLIP score, particularly in the score 2- to 3- patient groups of HCC, had greater discriminant ability and survival predictive power, but was not able to discriminate 4- to 6- patient group. (Korean J Hepatol 2006;12:209-220)

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Hepatology Elsewhere

The Korean Journal of Evaluation of the Heptocellular Carcinoma Staging Systems: Soon Ho Um; Korean J Hepatol 2006;12(2):251-256.

Abstract
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Background/Aims
The Barcelona Clinic Liver Cancer (BCLC) classification offers a prognostic stratification of patients with hepatocellular carcinoma (HCC). We recently demonstrated the BCLC’s peculiar prognostic ability in a retrospective cohort of HCC patients. The aim of this study was to evaluate the BCLC system prospectively in a subsequent separate group of HCC patients enrolled at the same surgically oriented liver unit. Methods: One hundred and ninety- five consecutive HCC patients were prospectively enrolled and their liver disease was staged before therapy. Unlike the BCLC treatment protocol, nodule size and number were not used as absolute exclusion criteria for radical treatment. Predictors of survival were identified using the Cox model. Results: The median survival time was 23 months overall, and 53, 16, 7 and 3 months, respectively, for BCLC categories A, B, C, and D. In our cohort, BCLC had the best independent predictive power for survival when compared with the Okuda, CLIP, UNOS-TNM, and JIS prognostic systems (linear trend χ2=43.01, likelihood χ2=57.94, AIC 885.98). Moreover, the BCLC classification showed a better prognostic ability than the AJCC-TNM 2002 system in surgical patients. Conclusions: The discriminating power of BCLC staging was prospectively assessed in an Italian cohort of HCC patients treated mainly with radical therapies. [Abstract reproduced by permission of J Hepatol 2006;44:723-31]

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Original Article

Evaluation of Predictive Value of Okuda, TNM, CLIP and JIS Staging Systems for Hepatocellular Carcinoma Patients: Sung-Wook Lee, M.D., Sang-Young Han, M.D., Kyoung-Tae Kim, M.D., Yang-Hyun Baek, M.D., In Young Koh, M.D., Byoung-Hee Kim, M.D., Eun-Hee Park, M.D., Jin-Seok Jang, M.D., Myung-Hwan Roh, M.D, Jong Cheol Choi, M.D.; Korean J Hepatol 2007;13(2):196-207.

Abstract
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Background/Aims
The aims of this study were to validate the prognostic value of the JIS score for HCC and to compare discriminatory ability and predictive power with other staging systems such as Okuda, TNM and CLIP. Methods: We analyzed the clinical records of 210 patients who were diagnosed as HCC from 2000 to 2002. Univariate and multivariate survival analyses were done to find out factors to affect survival. To validate prognostic value of those staging systems, survival curve was obtained and analyzed by the Kaplan-Meier’s method, and to compare discriminatory ability and predictive power, Homogeneity LR X² test and AIC score were used. Results: The median survival was 19.5 months (19.1±14.9). The number of patients and 3-year survival rate for those staging systems were Okuda 1(126, 57.7%), 2(63, 9.0%) and 3(21, 0.0%) (p<0.001); TNM I (34, 63.1%), II (71, 59.4%), III (50, 22.4%), IV-A (6, 14.3%) and IV-B (1, 6.5%) (p<0.001); CLIP 0 (79, 68.5%), 1 (39, 34.2%), 2 (36, 16.7%), 3 (25, 20.0%), 4 (18, 5.1%), 5 (9, 11.1%) and 6 (4, 0.0%) (p<0.001) and JIS 0 (26, 78.9%), 1 (65, 65.3%), 2 (43, 21.9%), 3 (40, 25, 8.0%) and 5 (11, 2.0%)(p<0.001) in univariate analysis using Kaplan-Meier analysis. Homogeneity LR X² test showed more stratification power in JIS (Okuda, 102.8; TNM, 128.2; CLIP, 148.4 and JIS, 185.6) and AIC score showed superior predictive power in JIS system (Okuda, 1228.5; TNM, 1130.3; CLIP, 1117.1 and JIS, 1093.6). Conclusions: The proposed JIS system is useful system to predict survival of HCC patients. The discriminate ability of the JIS score is much better than other staging systems and has better prognostic predictive power compared to other staging systems. (Korean J Hepatol 2007;13:196-207)