Validation of the BCLC Prognostic System in Surgical Hepatocellular Cancer Patients

Vitale, Alessandro; Saracino, E; Boccagni, Patrizia; Brolese, Alberto; D’Amico, Francesco; Gringeri, Enrico; Neri, Daniele; Srsen, N; Valmasoni, Michele; Zanus, Giacomo; Carraro, Amedeo; Violi, Paola; Pauletto, A; Bassi, Daniela; Polacco, M.; Burra, Patrizia; Farinati, Fabio; Feltracco, Paolo; Romano, A.; D, D'Amico; Cillo, Umberto

doi:10.1016/j.transproceed.2009.03.054

Cited by 52 publications

(32 citation statements)

References 12 publications

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“…The conclusion should therefore be interpreted with caution. To address the efficacy of local ablative therapy in comparison with [21,22]. A surgical approach has also been adopted in this patient population.…”

Section: Early-stage Hccmentioning

confidence: 99%

“…A surgical approach has also been adopted in this patient population. Vitale et al reported that the 3-year survival rate among patients with intermediate-stage HCC who underwent surgery was 56% compared to 13% among those who did not [22]. It has been suggested that liver transplantation should be considered critical for intermediate-stage HCC [23].…”

Section: Early-stage Hccmentioning

confidence: 99%

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Treatment of Hepatocellular Carcinoma: A Systematic Review

Hoffmann²,

2012

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Hepatocellular carcinoma (HCC) is one of the most common malignancies, with an increasing incidence. With advances in surgical techniques and instrumentation and the development of molecular-target drugs, a number of potentially curative treatments have become available. Management of HCC patients depends on the stage of their tumor. Liver resection remains the first choice for very early-stage HCC, but it is being challenged by local ablative therapy. For early-stage HCC that meet the Milan criteria, liver transplantation still offers a better outcome; however, local ablative therapy can be a substitute when transplantation is not feasible. Local ablation is also used as a bridging therapy toward liver transplantation. HCC recurrence is the main obstacle to successful treatment, and there is currently no effective means of preventing or treating HCC recurrence. Transarterial therapy is considered suitable for intermediate-stage HCC, while sorafenib is recommended for advanced-stage HCC. This stage-based approach to therapy not only provides acceptable outcomes but also improves the quality of life of HCC patients. Because of the complexity of HCC, therapeutic approaches ﾭcusses the current standards and trends in the treatment of HCC.

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Section: Early-stage Hccmentioning

confidence: 99%

Section: Early-stage Hccmentioning

confidence: 99%

Treatment of Hepatocellular Carcinoma: A Systematic Review

Hoffmann²,

2012

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“…Previous study indicated that the patients at the BCLC stage B and C undergoing resection could survive as long as the patients at stage A [17] . The previous study also indicated that the outcomes of patients at stages A, B, and C undergoing resection were much better than those of the patients receiving other treatments [18] . Some authors argued that neither multiple tumors nor portal hypertension were surgical contraindications for HCC [19] .…”

mentioning

confidence: 89%

Are surgical indications of Barcelona Clinic Liver Cancer staging classification justified?

Wei

Hao

Zhan

et al. 2011

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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Liver resection is the most effective treatment for hepatocellular carcinoma (HCC). The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no significant difference in the survival rate between the patients at stage A and B (P>0.05). If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B (77.7%, 80/103) would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.

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“…However, patients with intermediate HCC vary widely in tumor size, tumor volume, overall health, and other factors, and so derive different benefit from TACE. In recent years, many studies have validated the BCLC treatment recommendation [7,[18][19][20][21][22][23] . Liver resection has been widely performed in patients with intermediate HCC, and many investigators have argued that liver resection is as safe as TACE for intermediate HCC and provides better survival outcomes in selected patients [24][25][26][27][28][29][30][31] .…”

Section: Liver Resection Vs Tace For Intermediate Hccmentioning

confidence: 99%

“…Many multicenter studies with large sample sizes have validated liver resection for early HCC [35][36][37] . [18,24,39,40] . Nevertheless, a group of investigators reported survival benefits of liver resection for early HCC [41] .…”

Section: Prognostic Factors Of Survivalmentioning

confidence: 99%