Prognostic assessment using a new substaging system for Barcelona clinic liver cancer stage C hepatocellular carcinoma

A nationwide study

Research output: Contribution to journalArticle

Abstract

Aim & Background: Advanced hepatocellular carcinoma (HCC) (Barcelona clinic liver cancer [BCLC] stage C) needs subclassification to more accurately predict survival. This study aims to establish a substaging system of BCLC stage C HCC patients for accurate prognosis. Methods: Data from 564 patients with newly diagnosed BCLC stage C HCC from three tertiary-care hospitals affiliated with the Korea University (training set) were assessed retrospectively. Variables affecting overall survival (OS) were analysed, and patients were substaged according to the number of prognostic factors they fulfilled. The substaging system was validated using a nationwide database from the Korean Liver Cancer Association (validation set; n = 742). Results: In the training set, tumour factors such as tumour burden ≥10 cm, major portal vein invasion and distant metastasis, as well as underlying liver function, were independently associated with OS. BCLC stage C was classified into four substages (C1-4) according to the number of prognostic factors. Substages C1, C2, C3 and C4 showed a median OS of 17.50 months (95% confidence interval [CI], 8.57-26.43), 10.13 months (95% CI, 8.17-12.09), 4.20 months (95% CI, 3.42-4.98), and 2.90 months (95% CI, 2.34-3.46) respectively (P < 0.05). This substaging system also had good discriminative ability in predicting survival in the validation set. In addition, it was considered that the BCLC substaging is better than Hong Kong liver cancer substaging in predicting the OS for patients with advanced HCC. Conclusion: Our substaging for BCLC stage C might help predict patients' prognosis better.

Original languageEnglish
JournalLiver International
DOIs
Publication statusPublished - 2019 Jan 1

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Liver Neoplasms
Hepatocellular Carcinoma
Survival
Confidence Intervals
Hong Kong
Tertiary Healthcare
Korea
Portal Vein
Tumor Burden
Tertiary Care Centers
Databases
Neoplasm Metastasis
Liver
Neoplasms

Keywords

  • hepatocellular carcinoma
  • prognosis
  • stage
  • substaging
  • treatment

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{27696156d50b4639882cd92431a16d6b,
title = "Prognostic assessment using a new substaging system for Barcelona clinic liver cancer stage C hepatocellular carcinoma: A nationwide study",
abstract = "Aim & Background: Advanced hepatocellular carcinoma (HCC) (Barcelona clinic liver cancer [BCLC] stage C) needs subclassification to more accurately predict survival. This study aims to establish a substaging system of BCLC stage C HCC patients for accurate prognosis. Methods: Data from 564 patients with newly diagnosed BCLC stage C HCC from three tertiary-care hospitals affiliated with the Korea University (training set) were assessed retrospectively. Variables affecting overall survival (OS) were analysed, and patients were substaged according to the number of prognostic factors they fulfilled. The substaging system was validated using a nationwide database from the Korean Liver Cancer Association (validation set; n = 742). Results: In the training set, tumour factors such as tumour burden ≥10 cm, major portal vein invasion and distant metastasis, as well as underlying liver function, were independently associated with OS. BCLC stage C was classified into four substages (C1-4) according to the number of prognostic factors. Substages C1, C2, C3 and C4 showed a median OS of 17.50 months (95{\%} confidence interval [CI], 8.57-26.43), 10.13 months (95{\%} CI, 8.17-12.09), 4.20 months (95{\%} CI, 3.42-4.98), and 2.90 months (95{\%} CI, 2.34-3.46) respectively (P < 0.05). This substaging system also had good discriminative ability in predicting survival in the validation set. In addition, it was considered that the BCLC substaging is better than Hong Kong liver cancer substaging in predicting the OS for patients with advanced HCC. Conclusion: Our substaging for BCLC stage C might help predict patients' prognosis better.",
keywords = "hepatocellular carcinoma, prognosis, stage, substaging, treatment",
author = "Lee, {Dong won} and Yim, {Hyung Joon} and Seo, {Yeon Seok} and Na, {Seong Kyun} and Kim, {Seung Young} and Suh, {Sang Jun} and Hyun, {Jong Jin} and Jung, {Sung Woo} and Jung, {Young Kul} and Koo, {Ja Seol} and Kim, {Ji Hoon} and Yeon, {Jong Eun} and Lee, {Sang Woo} and Byun, {Kwan Soo} and Soon-Ho Um",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/liv.14117",
language = "English",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Prognostic assessment using a new substaging system for Barcelona clinic liver cancer stage C hepatocellular carcinoma

T2 - A nationwide study

AU - Lee, Dong won

AU - Yim, Hyung Joon

AU - Seo, Yeon Seok

AU - Na, Seong Kyun

AU - Kim, Seung Young

AU - Suh, Sang Jun

AU - Hyun, Jong Jin

AU - Jung, Sung Woo

AU - Jung, Young Kul

AU - Koo, Ja Seol

AU - Kim, Ji Hoon

AU - Yeon, Jong Eun

AU - Lee, Sang Woo

AU - Byun, Kwan Soo

AU - Um, Soon-Ho

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aim & Background: Advanced hepatocellular carcinoma (HCC) (Barcelona clinic liver cancer [BCLC] stage C) needs subclassification to more accurately predict survival. This study aims to establish a substaging system of BCLC stage C HCC patients for accurate prognosis. Methods: Data from 564 patients with newly diagnosed BCLC stage C HCC from three tertiary-care hospitals affiliated with the Korea University (training set) were assessed retrospectively. Variables affecting overall survival (OS) were analysed, and patients were substaged according to the number of prognostic factors they fulfilled. The substaging system was validated using a nationwide database from the Korean Liver Cancer Association (validation set; n = 742). Results: In the training set, tumour factors such as tumour burden ≥10 cm, major portal vein invasion and distant metastasis, as well as underlying liver function, were independently associated with OS. BCLC stage C was classified into four substages (C1-4) according to the number of prognostic factors. Substages C1, C2, C3 and C4 showed a median OS of 17.50 months (95% confidence interval [CI], 8.57-26.43), 10.13 months (95% CI, 8.17-12.09), 4.20 months (95% CI, 3.42-4.98), and 2.90 months (95% CI, 2.34-3.46) respectively (P < 0.05). This substaging system also had good discriminative ability in predicting survival in the validation set. In addition, it was considered that the BCLC substaging is better than Hong Kong liver cancer substaging in predicting the OS for patients with advanced HCC. Conclusion: Our substaging for BCLC stage C might help predict patients' prognosis better.

AB - Aim & Background: Advanced hepatocellular carcinoma (HCC) (Barcelona clinic liver cancer [BCLC] stage C) needs subclassification to more accurately predict survival. This study aims to establish a substaging system of BCLC stage C HCC patients for accurate prognosis. Methods: Data from 564 patients with newly diagnosed BCLC stage C HCC from three tertiary-care hospitals affiliated with the Korea University (training set) were assessed retrospectively. Variables affecting overall survival (OS) were analysed, and patients were substaged according to the number of prognostic factors they fulfilled. The substaging system was validated using a nationwide database from the Korean Liver Cancer Association (validation set; n = 742). Results: In the training set, tumour factors such as tumour burden ≥10 cm, major portal vein invasion and distant metastasis, as well as underlying liver function, were independently associated with OS. BCLC stage C was classified into four substages (C1-4) according to the number of prognostic factors. Substages C1, C2, C3 and C4 showed a median OS of 17.50 months (95% confidence interval [CI], 8.57-26.43), 10.13 months (95% CI, 8.17-12.09), 4.20 months (95% CI, 3.42-4.98), and 2.90 months (95% CI, 2.34-3.46) respectively (P < 0.05). This substaging system also had good discriminative ability in predicting survival in the validation set. In addition, it was considered that the BCLC substaging is better than Hong Kong liver cancer substaging in predicting the OS for patients with advanced HCC. Conclusion: Our substaging for BCLC stage C might help predict patients' prognosis better.

KW - hepatocellular carcinoma

KW - prognosis

KW - stage

KW - substaging

KW - treatment

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U2 - 10.1111/liv.14117

DO - 10.1111/liv.14117

M3 - Article

JO - Liver International

JF - Liver International

SN - 1478-3223

ER -