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Hepatocellular carcinoma (HCC) is one of the most common malignancies and a leading cause of cancer-related death worldwide. Surgery remains the primary and most successful therapy option for the treatment of early- and mid-stage HCCs, but the high heterogeneity of HCC renders prognostic prediction challenging. The construction of relevant prognostic models helps to stratify the prognosis of surgically treated patients and guide personalized clinical decision-making, thereby improving patient survival rates. Currently, the prognostic assessment of HCC is based on several commonly used staging systems, such as Tumor-Node-Metastasis (TNM), Cancer of the Liver Italian Program (CLIP), and Barcelona Clinic Liver Cancer (BCLC). Given the insufficiency of these staging systems and the aim to improve the accuracy of prognostic prediction, researchers have incorporated further prognostic factors, such as microvascular infiltration, and proposed some new prognostic models for HCC. To provide insights into the prospects of clinical oncology research, this review describes the commonly used HCC staging systems and new models proposed in recent years.
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Humans , Carcinoma, Hepatocellular/pathology , Liver Neoplasms/pathology , Prognosis , Neoplasm Staging , Survival Rate , Retrospective StudiesABSTRACT
Objective To investigate the risk factors of intrahepatic recurrence after resection for Barcelona Clinic Liver Cancer (BCLC) stage 0 hepatocellular carcinoma (HCC).Methods 58 patients with pathologically confirmed BCLC stage 0 HCC treated with liver resection at the Zhongshan Hospital,Fudan University from January to December 2011 were included in this study.The male/female ratio was 50/8.The age ranged from 31 to 72 years.The clinical,pathological and MR imaging features of these patients were analyzed.The recurrence-free survival rates between patients with HCC ≤ 1.5 cm (n=27) and ＞ 1.5 cm (n=31) were compared.The risk factors of intrahepatic recurrence for HCCs were compared using the Cox regression analysis.Results Intrahepatic recurrence was identified in 25 patients,and the median recurrence time was 33 months.The 3-and 5-year cumulative recurrence-free survival rates were 73.0％ (95％CI:60.7％～85.3％) and 52.3％ (95％CI:37.2％～67.4％).No significant differences were found in the recurrence-free survival rates between tumors ≤ 1.5 cm and ＞ 1.5 cm (P＞0.05).Multivariate analyses demonstrated that serum alpha-fetoprotein level ＞20 g/L (HR 3.773,95％CI:1.628～8.745;P＜0.05) and irregular tumor shape (HR 4.584,95％CI:1.485～ 14.155;P＜0.05) were independent risk factors of intrahepatic recurrence.Conclusions Elevated serum alpha-fetoprotein level and irregular tumor shape were associated with an increased risk of intrahepatic recurrence for BCLC stage 0 HCC patients after resection.They could be used as early prognostic indicators in clinical practice.
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Objectives To analyze prognosis and risk factors of Barcelona Clinical Liver Cancer (BCLC) stage B hepatocellular carcinoma patients treated with hepatectomy.Methods Clinical data of 162 BCLC stage B patients who underwent hepatectomy at Tianjin Medical University Cancer Institute & Hospital and the Second Hospital of Tianjin Medical University from June 2007 to December 2013 were retrospectively studied.The correlations between factors (age,gender) and long-term outcome were analyzed to determine independent risk factors.Subsequently,subgroup analysis of BCLC stage B hepatocellular carcinoma was performed.Results Multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were con firmed as independent risk factors of overall survival in postoperative BCLC B patients.Based on the risk factors,patients were divided into two groups,namely low-risk subgroup (≤ 1 risk factor) and high-risk subgroup (≥ 2 risk factors).In low-risk subgroup,1,3 and 5-year overall survival (OS) rates were 91.6％,65.5％,61.9％ respectively,and mean OS was 72 months.By contrast,1,3 and 5-year OS rates in high-risk subgroup were 67.4％,25.6％,10.8％ respectively,and mean OS was 29 months.Further more,1,3 and 5-year OS rates of all patients were 85.2％,54.9％,48.0％ respectively,and mean OS was 61 months.Conclusions Relatively favorable long-term outcomes could be yielded in BCLC stage B hepatocellular carcinoma patients treated with liver resection.The independent risk factors including multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were closely correlated with overall survival.BCLC stage B hepatocellular carcinoma patients could be divided into low-risk and high-risk subgroups based on the risk factors mentioned above.Survival rates in low-risk subgroup are remarkably superior to those in high-risk subgroup.
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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.