A new substage classification strategy for Barcelona Clinic Liver Cancer stage B patients with hepatocellular carcinoma

Abstract

Background and Aim:Patients with Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma are a heterogeneous population, and the classifications available could not predict the prognosis accurately. Herein, we proposed a new substage classification method, Scoring Method for Intermediate Stage, for precise classification and clinical guidance in hepatocellular carcinoma patients within Barcelona Clinic Liver Cancer stage B. Methods: A total of 1026 stage B patients of hepatocellular carcinoma who underwent transcatheter arterial chemoembolization as a first-line treatment in Liver Cancer Institute, Zhongshan Hospital, Fudan University were retrospectively enrolled. The prognostic evaluation ability of the new substage classification criteria was analyzed, in comparison with the existing substage classification criteria. Results: Using Scoring Method for Intermediate Stage, 1026 stage B patients were subclassified into three subgroups, based on Child-Pugh score and up-to-7 grade, as B1 (scoring 2), B2 (scoring 3 or 4), and B3 (scoring 5 or 6). The median survival time of the three substages was 29 (95% confidence interval [CI]: 25-36), 19 (95% CI: 16-21), and 10 (95% CI: 8-12) months, respectively. More favorable discrimination efficacy was identified by the new criteria in comparison with the existing substage classification criteria, including Bolondi, Kinki, MICAN, and Kim's criteria. Moreover, multivariate analyses indicated that the novel classification was highly associated with prognosis (Hazard ratio(s) = 1.63, 95% CI: 1.43-1.86, P < 0.001). Conclusions: Scoring Method for Intermediate Stage demonstrates satisfying capacity in classifying patients with stage B hepatocellular carcinoma and predicting prognosis.

Trans-arterial chemoembolization with degradable starch microspheres (DSM-TACE) versus selective internal radiation therapy (SIRT) in multifocal hepatocellular carcinoma

“…It is assumed that the reason is that although the patient population in the present study consisted of BCLC B patients, the present collective had a dismal prognosis in general due to the multifocal growth. Patients classified as BCLC B are still a heterogeneous population (34,35). In 2012, Bolondi et al.…”

“…A recent study by Hu et al. (35) introduced a new scoring system strategy for BCLC B substage classification (SMIS criteria) in a total of 2016 patients also combining liver function, number of lesions, and lesion diameter. Due to the number of lesions, the patients in the present collective would have been subclassified as B3 according to the SMIS criteria.…”

“…The median survival time in substage was 10 months, in line with the 9.5 months reported in the present study. It is noticeable that the survival time in the highest B substages according to Bolondi (B4), Kinki (B3b), MICAN (B4), and the Kim criteria (B3) was in the range of 7–10 months (35).…”

Prognostic value of expanded liver transplantation criteria—the 5‐5‐500 rule—in patients with hepatic resection for intermediate‐stage hepatocellular carcinoma

“…21 Thereafter, the "up-to-7 criteria" have been applied to elucidate the tumor burden in an attempt to develop a subclassification of BCLC-B HCC. 22,[23][24] In Japan, liver transplantation for BCLC-B patients within the 5-5-500 rule has been allowed in recent years. We selected the 5-5-500 rule to identify a subgroup of BCLC-B patients who have favorable survival after hepatic resection in our study.…”

“…A previous study proposed the “up‐to‐7 criteria” to identify a subgroup of HCC patients exceeding the Milan criteria who have favorable survival after liver transplantation 21 . Thereafter, the “up‐to‐7 criteria” have been applied to elucidate the tumor burden in an attempt to develop a subclassification of BCLC‐B HCC 22,23‐24 . In Japan, liver transplantation for BCLC‐B patients within the 5‐5‐500 rule has been allowed in recent years.…”