Validation of a Modified Substaging System (Kinki Criteria) for Patients with Intermediate-Stage Hepatocellular Carcinoma

Arizumi, Tadaaki; Ueshima, Kazuomi; Iwanishi, Mina; Minami, Tomohiro; Chishina, Hirokazu; Kono, Masashi; Takita, Masahiro; Kitai, Satoshi; Inoue, Takamitsu; Yada, Norihisa; Hagiwara, Satoru; Ida, Hiroshi; Minami, Yasunori; Sakurai, Toshiharu; Kitano, Masayuki; Nishida, Naoshi; Kudo, Masatoshi

doi:10.1159/000440631

Cited by 38 publications

(37 citation statements)

References 25 publications

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“…Substage B1 cases had a Child-Pugh score of 5-7 and met the up-toseven criteria; substage B2 cases had a Child-Pugh score of 5-7 and exceeded the up-to-seven criteria; substage B3 cases had a Child-Pugh score of 8-9 and any tumor status [20][21][22][23] .…”

Section: Kinki Criteriamentioning

confidence: 99%

The Overall Survival of Patients with Hepatocellular Carcinoma Correlates with the Newly Defined Time to Progression after Transarterial Chemoembolization

et al. 2017

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Aim/Background: The ultimate aim of any treatment for hepatocellular carcinoma (HCC) is to improve overall survival (OS); however, the clinical significance of time to progression (TTP) after transarterial chemoembolization (TACE) is unclear. This retrospective study examined the association between OS and the newly defined time to TACE progression (TTTP) to assess whether TTTP can be an alternative to OS in HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B. Methods: Between January 2006 and December 2013, 592 patients with HCC (BCLC B1, n = 118; BCLC B2, n = 170) underwent TACE. TTTP was then redefined as time to progression from the first image taken after TACE. The relationship between TTTP and OS was then examined based on survival time. Results: Survival analysis revealed significant differences in the OS of patients with BCLC B1 and those with BCLC B2 (median OS: 42.3 months, 95% confidence interval [CI] 34.4-50.7; and 29.3 months, 95% CI 26.1-37.6, respectively, p = 0.0348). The median TTTP values were 9.5 months (95% CI 7.0-10.9) and 5.3 months (95% CI 4.6-6.7), respectively ( p = 0.0078). There was a moderate positive correlation between OS and TTTP for both B1 ( R 2 = 0.6563, p = 0.0045) and B2 ( R 2 = 0.6433, p = 0.0052) substages. There was also a positive correlation between OS and TTTP for the combined B1 and B2 substages Conclusions: There was a moderate correlation between the TTTP and OS of patients with HCC after TACE therapy, where the patients with short TTTP represented short OS, indicating that TTTP is an alternative parameter for survival analysis of HCC patients with BCLC stage B tumors who undergo TACE.

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Section: Kinki Criteriamentioning

confidence: 99%

The Overall Survival of Patients with Hepatocellular Carcinoma Correlates with the Newly Defined Time to Progression after Transarterial Chemoembolization

et al. 2017

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“…Our substaging that is based on the Bolondi's subclassification is simple and easy to use compared to the Bolondi's substaging. Previously, we reported that the Kinki criteria could be well stratified based on the survival in patients who underwent TACE [24]. In this study, we further evaluated the performance of the Kinki criteria in the HCC patients irrespective of the type of treatment.…”

Section: Introductionmentioning

confidence: 99%

Validation of Kinki Criteria, a Modified Substaging System, in Patients with Intermediate Stage Hepatocellular Carcinoma

Arizumi

Ueshima

Iwanishi

et al. 2016

Dig Dis

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Background: The standard treatment option that is available for patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) is transarterial chemoembolization (TACE). However, the condition of the patients with BCLC stage B disease is heterogeneous showing different tumor statuses and Child-Pugh scores; treatment strategies other than TACE are frequently employed for the patients in this stage. Based on the subclassification system proposed by Bolondi et al. [Semin Liver Dis 2012;32:348-359], we developed the Kinki criteria focusing on a substaging for BCLC stage B disease, which is simpler and should be more suitable in actual clinical setting in Japan. In this study, we evaluated the performance of Kinki criteria. Summary: This study included 1,633 HCC patients who received first-line treatment at the Kindai University Hospital. Patients were classified into subgroups based on the Kinki criteria and the survival time was estimated for each group. There were 156 (33.3%) patients in subclass B1, 278 (59.3%) in B2, and 35 (7.4%) in B3. The median overall survival times and 95% CI for BCLC B subclasses B1, B2, and B3 were 4.3 years (3.7-4.9), 2.9 years (2.2-3.4), and 1.1 years (0.5-1.8), respectively (p < 0.001). Key Messages: Classification of HCC patients in BCLC stage B based on the Kinki criteria showed statistically significant differences in survival, indicating the performance of Kinki criteria, which takes Child-Pugh score and tumor status into account for determining treatment options for HCC in BCLC stage B.

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“…This subclassification of intermediate-stage HCC recently became a well-discussed issue, and the Kinki criteria are used to subclassify patients with intermediate-stage HCC [12,13] . The OS of patients with B1, B2, and B3 HCC according to the Kinki criteria corresponds to that of patients with HCC of BCLC stages A, B, and C. In addition, patients with BCLC substage B2 HCC, especially those with multiple HCC tumors in both lobes, are not good candidates for TACE.…”

Section: Hcc (Bclc-c) Patients With Intermediate-stage Hcc (Bclc-b)mentioning

confidence: 99%

A New Era of Systemic Therapy for Hepatocellular Carcinoma with Regorafenib and Lenvatinib

Kudo¹

2017

Liver Cancer

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HCC (BCLC-C), patients with intermediate-stage HCC (BCLC-B)were included in the SHARP study and the Asia Pacific study; therefore, sorafenib is a widely approved agent for systemic therapy not only for advanced-stage HCC but also for unresectable HCC (including intermediate-stage HCC). In fact, sorafenib is often administered to patients with intermediate-stage HCC (BCLC-B) in clinical practice and to 16.4-19.6% of patients in clinical trials worldwide [3][4][5] .The population of patients with intermediate-stage HCC is extremely heterogeneous, comprising 3 main subpopulations: (1) patients with a good prognosis who can be treated with curative therapy, (2) those for whom transarterial chemoembolization (TACE) is indicated, and (3) those for whom TACE is not recommended. This subclassification of intermediate-stage HCC recently became a well-discussed issue, and the Kinki criteria are used to subclassify patients with intermediate-stage HCC [12,13] . The OS of patients with B1, B2, and B3 HCC according to the Kinki criteria corresponds to that of patients with HCC of BCLC stages A, B, and C. In addition, patients with BCLC substage B2 HCC, especially those with multiple HCC tumors in both lobes, are not good candidates for TACE. For patients with intermediatestage HCC (BCLC-B) who do not respond to TACE, an early switch to sorafenib therapy (rather than repeat ineffective TACE) results in a better survival benefit; therefore, early identification of patients that are refractory to TACE is crucial [14][15][16][17] . These data underscore the importance of establishing globally recognized, common criteria for identifying TACE failure/ refractory patients in order to improve the survival of HCC patients [18] .

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Validation of a Modified Substaging System (Kinki Criteria) for Patients with Intermediate-Stage Hepatocellular Carcinoma

Cited by 38 publications

References 25 publications

The Overall Survival of Patients with Hepatocellular Carcinoma Correlates with the Newly Defined Time to Progression after Transarterial Chemoembolization

The Overall Survival of Patients with Hepatocellular Carcinoma Correlates with the Newly Defined Time to Progression after Transarterial Chemoembolization

Validation of Kinki Criteria, a Modified Substaging System, in Patients with Intermediate Stage Hepatocellular Carcinoma

A New Era of Systemic Therapy for Hepatocellular Carcinoma with Regorafenib and Lenvatinib

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