A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status
- Author:
Hyo Jung CHO
1
;
Soon Sun KIM
;
So Young KANG
;
Min Jae YANG
;
Choong Kyun NOH
;
Jae Chul HWANG
;
Sun Gyo LIM
;
Sung Jae SHIN
;
Kee Myung LEE
;
Byung Moo YOO
;
Kwang Jae LEE
;
Jin Hong KIM
;
Sung Won CHO
;
Jae Youn CHEONG
;
Author Information
- Publication Type:Multicenter Study
- Keywords: Hepatocellular carcinoma; Stage; Barcelona Clinic Liver Cancer Staging; Eastern Cooperative Oncology Group performance status
- MeSH: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Liver; Population Characteristics; Tumor Burden
- From:Gut and Liver 2019;13(5):557-568
- CountryRepublic of Korea
- Language:English
- 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.
