A Comparison of Staging Systems for Hepatocellular Carcinoma in a Multicenter US Cohort

Parikh, Neehar D.; Scaglione, Steven; Li, Yumeng; Powell, Corey; Yerokun, Olutola A.; Devlin, Pauline; Mumtaz, Shaham; Mittal, Sahil; Singal, Amit G.

doi:10.1016/j.cgh.2017.10.001

Cited by 15 publications

(9 citation statements)

References 8 publications

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“…Thus, Asians with HCC could particularly benefit from HKLC, since it indicates more aggressive curative treatments than the BCLC. However, like many previous studies, the present study involved a Western sample[8,23,27,28]. Only 6% of the cases were HBV related, and most patients had chronic HCV infection.…”

Section: Discussionmentioning

confidence: 96%

Cirrhotic patients and older people

Freitas

Longo

Santos

et al. 2019

WJH

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BACKGROUNDDespite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma (HCC) treatment, the Barcelona clinic liver cancer (BCLC) system has limitations, especially regarding intermediate-grade (BCLC-B) tumors. The recently proposed Hong Kong liver cancer (HKLC) staging system appears useful but requires validation in Western populations.AIMTo evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population, estimating the overall patient survival.METHODSThis was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016. Demographic, clinical, and laboratory data were collected. HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement. Overall survival was estimated based on the treatment proposed in each system.RESULTSA total of 519 HCC patients were assessed. Of these, 178 (34.3%) were HKLC-I; 95 (18.3%) HKLC-IIA; 47 (9.1%) HKLC-IIB; 29 (5.6%) HKLC-IIIA; 30 (5.8%) HKLC-IIIB; 75 (14.4%) HKLC-IV; and 65 (12.5%) HKLC-V. According to the BCLC, 25 (4.9%) were BCLC-0; 246 (47.4%) BCLC-A; 107 (20.6%) BCLC-B; 76 (14.6%) BCLC-C; and 65 (12.5%) BCLC-D. The general agreement between the two systems was 80.0% - BCLC-0 and HKLC-I (100%); BCLC-A and HKLC-I/HKLC-II (96.7%); BCLC-B and HKLC-III (46.7%); BCLC-C and HKLC-IV (98.7%); BCLC-D and HKLC-V (41.5%). When sub-classifying BCLC-A, HKLC-IIB, HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion, 13.4, 66.0, 100 and 36.7%, respectively, of the cases were classified as up-to-7 out.CONCLUSIONIn a Western population, the general agreement between the two systems was 80.0%, although in BCLC-B cases the agreement was low, suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC. The authors suggest that the BCLC system should be routinely employed, although for BCLC-B cases it should be associated with the HKLC system.

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Section: Discussionmentioning

confidence: 96%

Cirrhotic patients and older people

Freitas

Longo

Santos

et al. 2019

WJH

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“…Biopsy for the diagnosis of HCC is not currently routinely recommended by guidelines due to the risk of tumour seeding, bleeding and sampling error 6 . Similarly, the only validated non‐invasive prognostic markers for HCC are tumour staging and alpha‐fetoprotein levels, both of which have significant limitations in approximating tumour biology 7,8 . This is particularly important in light of recent data showing variation in tumour growth patterns, with one‐fourth of HCC having rapid growth patterns and over one‐third having indolent growth 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Systematic review: radiomics for the diagnosis and prognosis of hepatocellular carcinoma

Harding-Theobald

Louissaint

Maraj

et al. 2021

Aliment Pharmacol Ther

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Summary Background Advances in imaging technology have the potential to transform the early diagnosis and treatment of hepatocellular carcinoma (HCC) through quantitative image analysis. Computational “radiomic” techniques extract biomarker information from images which can be used to improve diagnosis and predict tumour biology. Aims To perform a systematic review on radiomic features in HCC diagnosis and prognosis, with a focus on reporting metrics and methodologic standardisation. Methods We performed a systematic review of all full‐text articles published from inception through December 1, 2019. Standardised data extraction and quality assessment metrics were applied to all studies. Results A total of 54 studies were included for analysis. Radiomic features demonstrated good discriminatory performance to differentiate HCC from other solid lesions (c‐statistics 0.66‐0.95), and to predict microvascular invasion (c‐statistic 0.76‐0.92), early recurrence after hepatectomy (c‐statistics 0.71‐0.86), and prognosis after locoregional or systemic therapies (c‐statistics 0.74‐0.81). Common stratifying features for diagnostic and prognostic radiomic tools included analyses of imaging skewness, analysis of the peritumoural region, and feature extraction from the arterial imaging phase. The overall quality of the included studies was low, with common deficiencies in both internal and external validation, standardised imaging segmentation, and lack of comparison to a gold standard. Conclusions Quantitative image analysis demonstrates promise as a non‐invasive biomarker to improve HCC diagnosis and management. However, standardisation of protocols and outcome measurement, sharing of algorithms and analytic methods, and external validation are necessary prior to widespread application of radiomics to HCC diagnosis and prognosis in clinical practice.

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“…Thus, the current staging systems still need improvement, for example, incorporating new risk factors for a better stratification of postoperative outcome. In fact, traditional staging systems mainly consist of pathological factors, like tumor size and vascular invasion, while tremendous information in preoperative computed tomography (CT) or magnetic resonance imaging (MRI) reflecting tissue intrinsic characters and heterogeneity [ 5 – 8 ] remains untapped. Recently, it has been reported that various imaging features were associated with pathological features and prognosis of the tumor and complementary to current staging systems, like rectal cancer and bladder cancer [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Radiomics score: a potential prognostic imaging feature for postoperative survival of solitary HCC patients

Bao¹,

Liu²,

Zhang³

et al. 2018

BMC Cancer

115

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BackgroundRadiomics is an emerging field in oncological research. In this study, we aimed at developing a radiomics score (rad-score) to estimate postoperative recurrence and survival in patients with solitary hepatocellular carcinoma (HCC).MethodsA total of 319 solitary HCC patients (training cohort: n = 212; validation cohort: n = 107) were enrolled. Radiomics features were extracted from the artery phase of preoperatively acquired computed tomography (CT) in all patients. A rad-score was generated by using the least absolute shrinkage and selection operator (lasso) logistic model. Kaplan-Meier and Cox’s hazard regression analyses were used to evaluate the prognostic significance of the rad-score. Final nomograms predicting recurrence and survival of solitary HCC patients were established based on the rad-score and clinicopathological factors. C-index and calibration statistics were used to assess the performance of nomograms.ResultsSix potential radiomics features were selected out of 110 texture features to formulate the rad-score. Low rad-score positively correlated with aggressive tumor phenotypes, like larger tumor size and vascular invasion. Meanwhile, low rad-score was significantly associated with increased recurrence and reduced survival. In addition, multivariate analysis identified the rad-score as an independent prognostic factor (recurrence: Hazard ratio (HR): 2.472, 95% confident interval (CI): 1.339–4.564, p = 0.004;survival: HR: 1.558, 95%CI: 1.022–2.375, p = 0.039). Notably, the nomogram integrating rad-score had a better prognostic performance as compared with traditional staging systems. These results were further confirmed in the validation cohort.ConclusionsThe preoperative CT image based rad-score was an independent prognostic factor for the postoperative outcome of solitary HCC patients. This score may be complementary to the current staging system and help to stratify individualized treatments for solitary HCC patients.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5024-z) contains supplementary material, which is available to authorized users.

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A Comparison of Staging Systems for Hepatocellular Carcinoma in a Multicenter US Cohort

Cited by 15 publications

References 8 publications

Cirrhotic patients and older people

Cirrhotic patients and older people

Systematic review: radiomics for the diagnosis and prognosis of hepatocellular carcinoma

Radiomics score: a potential prognostic imaging feature for postoperative survival of solitary HCC patients

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