Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population

Abstract

BACKGROUNDEarly allograft dysfunction (EAD) after liver transplantation (LT) is an important cause of morbidity and mortality. To ensure adequate graft function, a critical hepatocellular mass is required in addition to an appropriate blood supply. We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD.AIMTo study whether hepatic flow is an independent predictor of EAD following LT.METHODSThis is an observational cohort study in a single institution. Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow. EAD was defined using the Olthoff criteria. Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD. Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models.RESULTSA total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients. A total of 54 (27.7%) patients developed EAD. The median follow-up was 39 mo. Portal venous flow, hepatic arterial flow (HAF) and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses. HAF is an independent prognostic factor for 30-d patient mortality.CONCLUSIONIntraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD; Moreover, HAF should be considered a predictor of 30-d patient mortality.

Comparison of radiofrequency ablation combined with sorafenib or sorafenib alone in patients with ECOG performance score 1: identifying optimal candidates

“…Liver cancer is the seventh most common primary malignancy and the third-ranked cause of cancer-related mortality worldwide (1), of which hepatocellular carcinoma (HCC) accounts for more than 90% (2). The Barcelona Clinic Liver Cancer (BCLC) staging system, by right of its prominent advantages in its prognostic prediction, has been widely adopted for treatment allocation in clinical practice (3,4). Due to dormant and asymptomatic characteristics, a large portion of the HCC patients are diagnosed at an advanced stage beyond the optimal indications of curative treatments like hepatectomy, liver transplantation, and radiofrequency ablation (RFA) (5).…”

Impact of preoperative TACE on incidences of microvascular invasion and long‐term post‐hepatectomy survival in hepatocellular carcinoma patients: A propensity score matching analysis

“…Esophageal and gastric varices were diagnosed by esophagogastroduodenoscopy. The Barcelona Clinic Liver Cancer (BCLC) staging classification was used for tumor staging 18 …”

Living donor liver transplantation for patients with advanced hepatocellular carcinoma

“…The Barcelona Clinic Liver Cancer (BCLC) classification, the most used in Western countries, and the Hong Kong Liver Cancer (HKLC) staging system, which was created as a treatment guidance for Asian patients with HCC and is mainly used in Asian countries. Both classification systems use parameters such as presence of extrahepatic vascular invasion, tumor size, and number of nodules to stage HCC and provide management recommendations [8][9][10][11] .…”

“…Despite both classifications being widely used, their differences complicate the decision-making process for the transplant team when presented with an advanced HCC. In a recent Brazilian study [9] , 519 patients diagnosed with HCC were staged according to the BCLC and HKLC system with the aim to analyze therapeutic approach for different stages. The authors found that between both systems, there was high general agreement regarding therapeutic management of HCC in the Western population.…”

“…It is crucial that HCC staging be conducted in an individualized manner, taking into account biological and etiological heterogeneity among populations in order to provide the patient with the best treatment option available in their case [9] .…”