Applicability of the BCLC staging system to patients with hepatocellular carcinoma in Korea: analysis at a single center with a liver transplant center
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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.
Abstract
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.
참고문헌 (19)
- Greene F, "Liver including intrahepatic bile ducts, In American Joint Committee on cancer staging manual. 6th ed", pp.131~144 (2002), Springer
- Okuda K, "Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients", Cancer, 56, pp.918~928 (1985)
- Forner A, "Current strategy for staging and treatment: the BCLC update and future prospects", Semin Liver Dis, 30, pp.61~74 (2010)
- Llovet JM, "Hepatocellular carcinoma", Lancet, 362, pp.1907~1917 (2003)
- The Cancer of the Liver Italian Program (CLIP) Investigators, "Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma", Hepatology, 31, pp.840~845 (2000)
- Chevret S, "A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire", J Hepatol, 31, pp.133~141 (1999)
- Kudo M, "Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score)", J Gastroenterol, 38, pp.207~215 (2003)
- Tateishi R, "Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients", Gut, 54, pp.419~425 (2005)
- 정재연, "간세포암종의 표적치료제 Sorafenib", 대한소화기학회지, 52(4), pp.268~269 (2008), 대한소화기학회
- Cheng AL, "Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial", Lancet Oncol, 10, pp.25~34 (2009)
- Kim KM, "Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion", J Gastroenterol Hepatol, 24, pp.806~814 (2009)
- Kim DY, "Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma", Cancer, 103, pp.2419~2426 (2005)
- Marrero JA, "Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort", Hepatology, 41, pp.707~716 (2005)
- Cillo U, "Prospective validation of the Barcelona Clinic Liver Cancer staging system", J Hepatol, 44, pp.723~731 (2006)
- Lee HJ, "Living donor exchange program for adult living donor liver transplantation: preliminary experience at the Asan medical center, Korea", J Korean Soc Transplant, 22, pp.92~96 (2008)
- Park SJ, "Emergency adult-to-adult living-donor liver transplantation for acute liver failure in a hepatitis B virus endemic area", Hepatology, 51, pp.903~911 (2010)
- de Villa VH, "Ethics and rationale of living-donor liver transplantation in Asia", Transplantation, 75, pp.2~5 (2003)
- Lee HS, "The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study", Cancer, 79, pp.2087~2094 (1997)
- Chung JW, "Hepatocellular carcinoma and portal vein invasion: results of treatment with transcatheter oily chemoembolization", AJR Am J Roentgenol, 165, pp.315~321 (1995)