A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status
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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.
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.
참고문헌 (34)
- Bruix J, "Management of hepatocellular carcinoma : an update", Hepatology, 53, pp.1020~1022 (2011)
- Forner A, "Hepatocellular carcinoma", Lancet, 379, pp.1245~1255 (2012)
- European Association for the Study of the Liver, "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Yu SJ, "A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world : 2010-2016", Clin Mol Hepatol, 22, pp.7~17 (2016)
- Bolondi L, "Heterogeneity of patients with intermediate(BCLC B)Hepatocellular carcinoma : proposal for a subclassification to facilitate treatment decisions", Semin Liver Dis, 32, pp.348~359 (2012)
- Yamakado K, "Sub-classification of intermediate-stage(Barcelona Clinic Liver Cancer stage-B)hepatocellular carcinomas", World J Gastroenterol, 21, pp.10604~10608 (2015)
- Kudo M, "Subclassification of BCLC B stage hepatocellular carcinoma and treatment strategies : proposal of modified Bolondi’s subclassification(Kinki criteria)", Dig Dis, 33, pp.751~758 (2015)
- Ha Y, "Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis", J Gastroenterol Hepatol, 29, pp.787~793 (2014)
- Llovet JM, "Prognosis of hepatocellular carcinoma : the BCLC staging classification", Semin Liver Dis, 19, pp.329~338 (1999)
- Oken MM, "Toxicity and response criteria of the Eastern Cooperative Oncology Group", Am J Clin Oncol, 5, pp.649~655 (1982)
- Chen YM, "Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with relatively good performance status", J Chin Med Assoc, 74, pp.209~214 (2011)
- Taylor AE, "Observer error in grading performance status in cancer patients", Support Care Cancer, 7, pp.332~335 (1999)
- Sørensen JB, "Performance status assessment in cancer patients", Br J Cancer, 67, pp.773~775 (1993)
- Chan SC, "Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion", Hepatol Int, 6, pp.646~656 (2011)
- Hsu CY, "Performance status in patients with hepatocellular carcinoma : determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system", Hepatology, 57, pp.112~119 (2013)
- Hollebecque A, "Safety and efficacy of sorafenib in hepatocellular carcinoma : the impact of the Child-Pugh score", Aliment Pharmacol Ther, 34, pp.1193~1201 (2011)
- Piscaglia F, "Treatment of hepatocellular carcinoma in Child-Pugh B patients", Dig Liver Dis, 45, pp.852~858 (2013)
- Hucke F, "The ART-strategy : sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE", J Hepatol, 60, pp.118~126 (2014)
- Chen XP, "Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma", Ann Surg Oncol, 13, pp.940~946 (2006)
- Quirk M, "Management of hepatocellular carcinoma with portal vein thrombosis", World J Gastroenterol, 21, pp.3462~3471 (2015)
- Pinter M, "Advanced-stage hepatocellular carcinoma : transarterial chemoembolization versus sorafenib", Radiology, 263, pp.590~599 (2012)
- Luo J, "Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis : a prospective comparative study", Ann Surg Oncol, 18, pp.413~420 (2011)
- 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)
- Leng JJ, "Efficacy of transarterial chemoembolization for hepatocellular carcinoma with portal vein thrombosis : a meta-analysis", ANZ J Surg, 86, pp.816~820 (2016)
- Sangro B, "Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona Clinic Liver Cancer stages : a European evaluation", Hepatology, 54, pp.868~878 (2011)
- Salem R, "Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres : a comprehensive report of long-term outcomes", Gastroenterology, 138, pp.52~64 (2010)
- 이정민, "Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis", Clinical and Molecular Hepatology, 22(1), pp.160~167 (2016), 대한간학회
- Woo HY, "New perspectives on the management of hepatocellular carcinoma with portal vein thrombosis", Clin Mol Hepatol, 21, pp.115~121 (2015)
- Mazzaferro V, "Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria : a retrospective, exploratory analysis", Lancet Oncol, 10, pp.35~43 (2009)
- D’Amico F, "Predicting recurrence after liver transplantation in patients with hepatocellular carcinoma exceeding the up-to-seven criteria", Liver Transpl, 15, pp.1278~1287 (2009)
- Prasad KR, "Summary of candidate selection and expanded criteria for liver transplantation for hepatocellular carcinoma : a review and consensus statement", Liver Transpl, 17, pp.S81~ (2011)[DOI]
- Giannini EG, "Application of the intermediate-stage subclassification to patients with untreated hepatocellular carcinoma", Am J Gastroenterol, 111, pp.70~77 (2016)
- Lee S, "Subclassification of Barcelona Clinic Liver Cancer B and C hepatocellular carcinoma : a cohort study of the multicenter registry database", J Gastroenterol Hepatol, 31, pp.842~847 (2016)
- Sinn DH, "Different survival of Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread", PLoS One, 10, pp.e0124434~ (2015)