BCLC subclassification and tumour characteristics to provide prognostication of outcomes in an Asian population of locally advanced hepatocellular carcinoma treated using selective internal radiation therapy with Yttrium-90.

Abstract

443 Background: Selective internal radiation therapy (SIRT) with Yttrium-90 (Y90) is preferentially used in locally advanced hepatocellular carcinoma (HCC) patients in the Barcelona clinic liver cancer (BCLC) B or C cohort. However, the BCLC B cohort has a wide heterogeneity. To address this, Bolondi et al. proposed a BCLC B subclassification system. Additionally, the BCLC C cohort is also diverse in their Child-Pugh (CP) stage and extent of portal vein thrombosis (PVT). The effect of these subclassifications on survival outcomes has not been studied in HCC patients treated using SIRT. Methods: 392 HCC patients treated using SIRT from 1st January 2008 to 17th March 2017 were analyzed. These patients were classified according to the proposed subclassification system for the BCLC B cohort, and CP stage for the BCLC C cohort, and their survival outcomes reviewed. Results: 293 patients met the study’s inclusion criteria. For B1/B2/B3/B4/ C CP-A and C CP-B, the median OS was 48.3/28.7/14.4/13.7/12.8 and 6.6 months respectively. Overall comparison between the subgroups for median OS reached statistical significance (p < 0.001). The Cox proportional-hazards regression analysis found that tumour location defined as unilobar or bilobar disease significantly influenced median OS. In the BCLC C cohort, the extent of portal vein invasion significantly influenced median OS (p < 0.001). For the BCLC C CP-A group, median OS for segmental/sectoral branch invasion, right and/or left portal vein invasion and main portal vein trunk invasion was 24.1, 12.8 and 6.5 months respectively. Conclusions: Bolondi et al.’s subclassification system optimizes prognostic prediction by reducing the clinical heterogeneity in BCLC B HCC patients treated using SIRT. However tumour location, unaccounted for in the proposed subclassification, is also an important prognosticator. For the BCLC C cohort CP stage, extent of PVT, and tumour location were important predictors of treatment outcomes.

A Retrospective Study on Predicting Recurrence of Intermediate-Stage Hepatocellular Carcinoma After Radical Therapy

“…Intermediate stage (stage B) HCC encompasses a highly heterogeneous population with diverse clinicopathological features and tumor biological behaviors, resulting in varying prognosis. 26 Therefore, stage B patients should be treated individually based on their specific clinicopathological characteristics. In 2012, Bolondi et al introduced a subcategorization of intermediate grade HCC.…”

Extending surgical resection for hepatocellular carcinoma beyond Barcelona Clinic for Liver Cancer (BCLC) stage A: A novel application of the modified BCLC staging system.

“…Specifically, the median OS of HCC in substage B1 (48.2 months) was almost twice of that in substage B2 (28.7), demonstrating significant disparity and heterogeneity within BCLC B HCC disease. 33 Although highlights of recent research have revolved around TACE and SIRT as evident above, there is mounting evidence supporting surgical resections beyond BCLC Stage A. 15,17,29 However, there are no studies to our knowledge that have attempted to incorporate the refined BCLC system as proposed by Bolondi et al 27 to specifically prognosticate various substages within BCLB Stage B after surgical resection.…”

Extending Surgical Resection for Hepatocellular Carcinoma Beyond Barcelona Clinic for Liver Cancer (BCLC) Stage A: A Novel Application of the Modified BCLC Staging System

“…Specifically, the median OS of HCC in substage B1 (48.2 months) was almost twice of that in substage B2 (28.7), demonstrating significant disparity and heterogeneity within BCLC B HCC disease. 33 …”