BCLC-B Subclassification and the Hong Kong Liver Cancer System in Intermediate Hepatocellular Carcinoma

Abstract

Introduction: The intermediate stage of the Barcelona Clinic Liver Cancer (BCLC) classification includes a heterogenous population of patients with hepatocellular carcinoma (HCC), and palliative treatment with transarterial chemoembolization is recommended for all of them. In this regard, 2 other classifications could be useful, the subclassification BCLC-B (SUB) and the classification Hong Kong Liver Cancer (HKLC). Objective: To determine the indication of curative or palliative treatment between SUB and HKLC in BCLC-B patients. Patients and Methods: A retrospective study in HCC patients seen between 2011 and 2016 in southern Brazil. Demographic, clinical, and laboratory data were collected. HCC staging was performed with BCLC, SUB, and HKLC. Results: A total of 570 patients with HCC were assessed, of whom 95 were classified as BCLC-B: 25 (26.0%) B1, 48 (50.5%) B2, 9 (9.5%) B3, and 13 (13.7%) B4. Overall median survival was 21.1 (95% confidence interval, 14.2-28.0) months. Median survival was higher for BCLC-B1 patients than in subgroups B3 (P=0.046) and B4 (P=0.001), and this was also seen for B2 versus B4 (P=0.044). Regarding the HKLC classification, a significantly higher median survival was observed for HKLC-I and HKLC-IIB in relation to the categories HKLC-IIIA (P<0.001 and 0.004, respectively) and HKLC-IIIB (P<0.001 and 0.006, respectively). When HKLC was applied, the following were identified as candidates for curative treatment: BCLC-B1, 24 (96.0%); BCLC-B2, 26 (54.2%); BCLC-B3, 0 (0%); and BCLC-B4, 3 (23.1%). Conclusion: In intermediate HCC, SUB was able to identify a subset of patients with a higher overall survival. According to HKLC, 55.8% of BCLC-B patients could receive curative treatment.

Cirrhotic patients and older people

“…Although the up-to-7 criterion is an anatomopathological, rather than radiological, classification, it has been used in a similar fashion in clinical practice. However, rather than indicating a limitation in these systems, it shows that therapy should be individualized[38]. We found BCLC-A and HKLC-IIB, HKLC-IIIA and HKLC-IIIB up-to-7 out patients who would not qualify as liver transplant candidates due to their tumor volume[39,40], as well as HKLC-IIIA and HKLC-IIIB patients who would not qualify as TACE candidates because they have nodules larger than 10 cm or have decompensated cirrhosis (CP-B and CP-C)[41].…”