The recommended treatment algorithms of the <scp>BCLC</scp> and <scp>HKLC</scp> staging systems: does following these always improve survival rates for <scp>HCC</scp> patients?

Kim, Kwang Min; Sinn, Dong Hyun; Jung, Sin‐Ho; Gwak, Geum‐Youn; Paik, Yong–Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

doi:10.1111/liv.13107

Cited by 60 publications

(61 citation statements)

References 31 publications

(32 reference statements)

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“…However, some systems are not consistent across all stages; for example, CLIP was more discriminating in early (score 0-3) than later (score 4-6) disease stages [51]. Survival was also found to be better when patients received recommended treatment in stages HKLC I, IIa/b, IIIa, or Va than in stages IIIb, IVa/b, or Vb, and when patients received recommended treatment in BCLC stages 0 or A, but not in stages B, C, or D. In addition, neither system (HKLC or BCLC) could direct therapy for a large group of patients [53].…”

Section: Staging Systemsmentioning

confidence: 89%

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

2018

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Background: Liver cancer is the second most common cause of cancer-related death, with hepatocellular carcinoma (HCC) accounting for most primary liver cancers and most commonly arising from a history of advanced chronic liver disease. Among the available therapies, transarterial chemoembolization (TACE) is the most widely utilized and is considered the first-line treatment recommended for patients staged as intermediate HCC (Barcelona Clinic Liver Cancer stage B). If applied correctly, TACE can produce survival benefits without adversely affecting hepatic functional reserve. Summary: The aim of this nonsystematic review is to evaluate the evidence supporting TACE, with a special interest in intermediate HCC, for which this treatment is recommended in first line. However, intermediate HCC represents a broad and heterogeneous group of patients, not all of whom will benefit from TACE. This review highlights the importance of appropriate patient selection for initial TACE and for retreatment. It also evaluates evidence for the treatment of patients who become refractory to TACE. Some patients may, in fact, benefit from early switch (i.e., after 1 or 2 TACE treatments) to systemic therapies rather than continuing retreatments with TACE in order to preserve liver function, thus allowing sequential first- and second-line drug therapies. Key Messages: Careful assessment of an individual patient's benefit/risk ratio is recommended before any TACE session is considered to ensure optimal long-term outcomes in intermediate HCC.

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Section: Staging Systemsmentioning

confidence: 89%

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

2018

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“…Studies suggest that the BCLC system can predict prognosis more accurately for Caucasian HCC patients than Asian ones, while the converse may be true of the HKLC system [8–11]. Though both staging systems are comprehensive, many patients do not fall neatly into their pre-specified treatment pathways [11], and even patients within the same BCLC or HKLC stage can differ substantially.…”

Section: Discussionmentioning

confidence: 99%

“…Though both staging systems are comprehensive, many patients do not fall neatly into their pre-specified treatment pathways [11], and even patients within the same BCLC or HKLC stage can differ substantially. These treatment gaps highlight the need to assess actual tumor stages and primary treatments of HCC in large patient populations.…”

Section: Discussionmentioning

confidence: 99%

Tumor stage and primary treatment of hepatocellular carcinoma at a large tertiary hospital in China: A real-world study

et al. 2017

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The current clinical reality of tumor stages and primary treatments of hepatocellular carcinoma (HCC) is poorly understood. This study reviewed the distribution of tumor stages and primary treatment modalities among a large population of patients with primary HCC. Medical records of patients treated between January 2003 and October 2013 for primary HCC at our tertiary hospital in China were retrospectively reviewed. A total of 6241 patients were analyzed. The distribution of Barcelona Clinic Liver Cancer (BCLC) stages was as follows: stage 0/A, 28.9%; stage B, 16.2%; stage C, 53.6%; stage D, 1.3%. The distribution of Hong Kong Liver Cancer (HKLC) stages was as follows: stage I, 8.4%; stage IIa, 1.5%; stage IIb, 29.0%; stage IIIa, 10.0%; stage IIIb, 33.6%; stage IVa, 3.4%; stage IVb, 2.5%; stage Va, 0.2%; stage Vb, 11.4%. The most frequent therapy was hepatic resection for patients with BCLC-0/A/B disease, and transarterial chemoembolization for patients with BCLC-C disease. Both these treatments were the most frequent for patients with HKLC I to IIIb disease, while systemic chemotherapy was the most frequent first-line therapy for patients with HKLC IVa or IVb disease. The most frequent treatment for patients with HKLC Va/Vb disease was traditional Chinese medicine. In conclusion, Prevalences of BCLC-B and -C disease, and of HKLC I to IIIb disease, were relatively high in our patient population. Hepatic resection and transarterial chemoembolization were frequent first-line therapies.

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“…However, in clinical practice, resection, transplantation or local ablation is infeasible in many cases [10]. For hepatic resection, hepatic reservoir function and future liver volume or remnant liver volume after resection should be considered in order to prevent postoperative hepatic insufficiency [1].…”

Section: Discussionmentioning

confidence: 99%

“…We screened Samsung Medical Center HCC registry for the period from January 2007 to December 2012. Detailed description of Samsung Medical Center HCC registry has been described in our previous paper [10]. Briefly, all newly-diagnosed HCC patients who received care at our institution were prospectively registered.…”

Section: Methodsmentioning

confidence: 99%

The role of scheduled second TACE in early-stage hepatocellular carcinoma with complete response to initial TACE

et al. 2017

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Background/AimsWe investigated the outcomes of early-stage hepatocellular carcinoma (HCC) patients who showed a complete response (CR) to initial transarterial chemoembolization (TACE), with a focus on the role of scheduled TACE repetition.MethodsA total of 178 patients with early-stage HCC who were initially treated with TACE and showed a CR based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria on one month follow-up computed tomography (CT) were analyzed. Among them, 90 patients underwent scheduled repetition of TACE in the absence of viable tumor on CT.ResultsDuring a median follow-up period of 4.6 years (range: 0.4-8.8 years), mortality was observed in 71 patients (39.9%). The overall recurrence-free and local recurrence-free survival rates at 1 year were 44.4% and 56.2%. In the multivariable model, scheduled repetition of TACE was an independent factor associated with survival (hazard ratio [95% confidence interval]: 0.56 [0.34-0.93], P=0.025). When stratified using Barcelona clinic liver cancer (BCLC) stage, scheduled repetition of TACE was associated with a favorable survival rate in BCLC stage A patients, but not in BCLC 0 patients.ConclusionsScheduled repetition of TACE was associated with better survival for early-stage HCC patients showing a CR after initial TACE, especially in BCLC stage A patients.

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The recommended treatment algorithms of the BCLC and HKLC staging systems: does following these always improve survival rates for HCC patients?

Abstract: Both the BCLC and HKLC staging systems effectively stratified patient prognosis, but neither could direct therapy for a large proportion of patients; for some stages, recommended therapy was associated with worse prognosis.

Cited by 60 publications

References 31 publications

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

Tumor stage and primary treatment of hepatocellular carcinoma at a large tertiary hospital in China: A real-world study

The role of scheduled second TACE in early-stage hepatocellular carcinoma with complete response to initial TACE

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