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Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single centre experience from long-term clinical outcomes of 1717 treatment-naïve patients with hepatocellular carcinoma

 Beom Kyung Kim  ;  Seung Up Kim  ;  Jun Yong Park  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Mi Sung Park  ;  Eun Hye Kim  ;  Jinsil Seong  ;  Do Youn Lee  ;  Kwang-Hyub Han 
 LIVER INTERNATIONAL, Vol.32(7) : 1120-1127, 2012 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/therapeutic use ; Benzenesulfonates/therapeutic use ; Carcinoma, Hepatocellular/drug therapy ; Carcinoma, Hepatocellular/mortality* ; Carcinoma, Hepatocellular/pathology* ; Child ; Female ; Hepatitis B/epidemiology ; Hepatitis C/epidemiology ; Humans ; Liver Neoplasms/drug therapy ; Liver Neoplasms/mortality* ; Liver Neoplasms/pathology* ; Male ; Middle Aged ; Neoplasm Staging ; Niacinamide/analogs & derivatives ; Phenylurea Compounds ; Prognosis ; Pyridines/therapeutic use ; ROC Curve ; Republic of Korea/epidemiology ; Treatment Outcome ; Young Adult
Barcelona Clinic Liver Cancer (BCLC) staging ; hepatocellular carcinoma ; prognosis ; survival ; treatment
BACKGROUND: The most informative staging system regarding survival outcomes for treatment-naïve hepatocellular carcinoma (HCC) remains debated. We evaluated prognostic values of Barcelona Clinic Liver Cancer (BCLC) stage compared with other staging systems, and identified discrepancies between treatment options chosen in Korean clinical practice and BCLC guidelines. METHODS: Between 2003 and 2008, 1717 prospectively enrolled patients with treatment-naïve HCC were analysed. Prognostic ability of each staging system was assessed using time-dependent receiver-operating characteristic (ROC) curves. RESULTS: The most common aetiology was hepatitis B virus (1238, 72.1%); 167 (9.8%) patients were classified as BCLC stage 0, 526 (30.6%) as A, 333 (19.4%) as B, 608 (35.4%) as C and 83 (4.8%) as D. Median overall survival was 22.5 months, and 1-, 2-, 3-, 4-, and 5-year survival rates were 62.6, 48.3, 39.9, 34.7, and 29.3% respectively. Of six staging systems, BCLC had the highest area under ROC (AUROC; 0.821) for overall survival, followed by JIS (0.809), Tokyo score (0.771), CLIP (0.746), CUPI (0.701) and GRETCH (0.685) system. In both subgroups stratified according to treatment strategy (curative vs. palliative), BCLC also showed the best AUROCs (curative, 0.708/palliative, 0.807) for overall survival. Regarding discrepancies between treatment options chosen in our cohort and BCLC guidelines, more than half with very early/early-stage HCC underwent transarterial chemoembolization, rather than resection or local ablative therapy; most of those with advanced-stage HCC received intra-arterial chemotherapy-based treatments rather than sorafenib. CONCLUSION: BCLC was the best long-term prognostic model for treatment-naïve HCC in a large-scale Korean cohort. However, treatment modalities did not exactly match BCLC paradigm.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Eun Hye(김은혜) ORCID logo https://orcid.org/0000-0001-6691-6837
Park, Mi Sung(박미성)
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Do Yun(이도연)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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