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

Abstract

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.

New intermediate‐stage subclassification for patients with hepatocellular carcinoma treated with transarterial chemoembolization

“…However, owing to the enormous heterogeneity of the population, the outcome prediction is also heterogeneous for patients with HCC of BCLC B stage after receiving TACE treatment . Thus, attempts have been made to develop a tailored subgroup stratification for the BCLC B stage, to provide prognosis and optimal treatment strategies in each substage. For the first time, Bolondi et al .…”

Proposal for subclassification to select patients for hepatectomy with intermediate hepatocellular carcinoma and Child–Pugh A liver function

“…This criterion radically differs from recent findings by Vitale et al [ 9 ] They argued that tumor size may not have an negative effect on the benefit of resection in intermediate stage HCC, suggesting that aggressive treatments should be considered, when clinically applicable, to achieve the maximum survival benefit. In contrast, cumulative tumor size independently affected OS of patients with BCLC stage B HCC in some series, [ 13 , 14 , 21 – 24 ] but there has been no consensus on which criteria should be used.…”

“…Arizumi et al [ 24 ] modified criteria for Bolondi's substaging system and recommended resection or even ablation for patients who met the up-to-7 criteria with well-preserved liver function. Although the Kinki criteria were suitable for subclassification of patients with intermediate stage HCC in a study by Arizumi et al [ 24 ] , more than 55% patients were classified as B2 stage and lost their chance of receiving surgery. Additionally, the effect of their treatment method was not shown in their series.…”

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

“…Studies have proposed subdividing patients with intermediate BCLC B-stage HCC because it consists of a heterogeneous population in terms of tumor size and number. [23,24] Interestingly, a recent report showed a higher propensity of TACE refractoriness and liver function deterioration in patients with intermediate-stage HCC beyond the Milan and beyond the up-to-7 criteria, defined by the Kinki criteria B2. [22] Similarly, in this study, the mean size of the largest tumor in the 45 patients who were refractory to repeated-TACE was 10.3 cm and 44.4% of those patients had 4 or more tumors.…”