BCLC stage B is a better designation for single large hepatocellular carcinoma than BCLC stage A

Jung, Young Kul; Jung, Cheulhee; Seo, Yeon Seok; Kim, Ji Hoon; Kim, Tae Hyung; Yoo, Yang Jae; Kang, Seong Hee; Yim, Sun Young; Suh, Sang Jun; An, Heeyoung; Yim, Hyung Joon; Yeon, Jong Eun; Byun, Kwan Soo; Um, Soon Ho

doi:10.1111/jgh.13152

Cited by 44 publications

(43 citation statements)

References 48 publications

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“…This was consistent with the findings of previous studies, which reported patients with SLHCC to have lower 5-year OS rates (36.8–42.9%) than those with BCLC stage A HCC (55.4–58.6%) [16, 17]. Our study further demonstrated that SLHCC patients had an intermediate OS rate between those in the BCLC stages A and B.…”

Section: Discussionsupporting

confidence: 82%

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Fang

Kao

et al. 2018

Liver Cancer

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Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

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Section: Discussionsupporting

confidence: 82%

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Fang

Kao

et al. 2018

Liver Cancer

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“…Although some studies have reported similar survival between single large HCCs and single small HCCs [25, 26], they were composed of well-selected patients who have received resection. However, most recent studies revealed that solitary large HCC should be classified at least as intermediate stage HCC [27, 28]. …”

Section: Discussionmentioning

confidence: 99%

Survival Analysis of Single Large (>5 cm) Hepatocellular Carcinoma Patients: BCLC A versus B

Cho

Sinn

et al. 2016

PLoS ONE

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Background & AimsSingle large (>5 cm) hepatocellular carcinoma (HCC) is classified as Barcelona Liver Clinic (BCLC) stage early stage (A). Yet, controversies exist whether single large HCC can be considered as early stage. We have analyzed long-term outcome to see which stage is appropriate for these patients.MethodsFrom 2005 to 2006, 1,546 consecutive patients who were newly diagnosed as HCC (BCLC A or B) at four tertiary hospitals in Korea were analyzed. BCLC A was sub-classified into A1 (single 2–5 cm), A2 (2–3 nodules ≤3 cm), and A3 (single >5 cm). BCLC B1 included patients beyond-Milan criteria, and within up-to-7 criterion. Survival prediction between subgroupings (1: A1 + A2 + A3 vs. B1 and 2: A1 + A2 vs. A3 + B1) was compared based on c-index and Akaike information criterion (AIC).ResultsThe 5-year overall survival (OS) rate was 62.3, 58.6, 36.8, and 42.0% for A1, A2, A3 and B1, respectively. In multivariate Cox-regression analysis, OS was significantly different between A3 + B1 vs. A1 + A2 (hazard ratio [HR] 1.85; P<0.001), but not between A1 + A2 + A3 vs. B1 (HR 1.19; P = 0.258). For A3, surgical resection showed superior OS over transarterial chemoembolization. Survival prediction was superior in subgrouping 2 (AIC 5727.2; c-index 0.652) than subgrouping 1 (AIC 5766.3; c-index 0.619) even after inverse probability weighting.ConclusionsThis large scale long-term follow-up data shows that single large tumor should be considered as intermediate stage in terms of prognosis. However, in terms of treatment, resection might be the first line treatment option.

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“…According to the AJCC (6th) staging manual, BCLC B is equal to parts of stage T3 and C is equal to part of stage T3 and T4, respectively [25]. Currently, patients with BCLC B are generally treated with TACE, and patients with BCLC C are treated with sorafenib alone.…”

Section: Discussionmentioning

confidence: 99%

Incorporation of alpha-fetoprotein(AFP) into subclassification of BCLC C stage hepatocellular carcinoma according to a 5-year survival analysis based on the SEER database

Zhang

Yin

et al. 2016

Oncotarget

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BCLC stage B is a better designation for single large hepatocellular carcinoma than BCLC stage A

Abstract: Patients in group 2 had a worse prognosis than those in group 1 and a similar prognosis to those in group 3. Our results suggest that BCLC stage B is the best stage designation for SLHCC.

Cited by 44 publications

References 48 publications

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Survival Analysis of Single Large (>5 cm) Hepatocellular Carcinoma Patients: BCLC A versus B

Incorporation of alpha-fetoprotein(AFP) into subclassification of BCLC C stage hepatocellular carcinoma according to a 5-year survival analysis based on the SEER database

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