Prospective validation of the Barcelona Clinic Liver Cancer staging system

Cillo, Umberto; Vitale, Alessandro; Grigoletto, Francesco; Farinati, Fabio; Brolese, Alberto; Zanus, Giacomo; Neri, Daniele; Boccagni, Patrizia; Srsen, N; D’Amico, Francesco; Ciarleglio, Francesco Antonio; Bridda, Alessio; D’Amico, Davide

doi:10.1016/j.jhep.2005.12.015

Cited by 381 publications

(284 citation statements)

References 39 publications

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“…Although the BCLC classification system is still widely used and is the most comprehensive staging system available, previous studies have demonstrated that the performance of the BCLC classification system may be better in Caucasian HCC patients and earlier-stage disease only (6)(7)(8)(9)13,32). Our data were consistent with these findings.…”

Section: Discussionsupporting

confidence: 92%

“…The staging of hepatocellular carcinoma (HCC) differs significantly from that of other malignancies, as the underlying liver disease, apart from the biology of the tumor itself, may significantly affect patient prognosis (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Based on the identification of relevant predictors for tumor burden and liver functional reserve, several staging systems for HCC including both aspects have been proposed in different parts of the world (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Of these prognostic systems for HCC, the Japan Integrated Staging (JIS) system, the Barcelona Clinic Liver Cancer (BCLC) classification system, the tumor-node-metastasis (TNM) classification system, the Cancer of the Liver Italian Program (CLIP) scoring system and the Chinese University Prognostic Index (CUPI) scoring system are currently used in daily clinical practice, with an ongoing debate between Western and Eastern countries regarding their prognostic ability in HCC (2,6,(10)(11)(12)14).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience

Endo

Nishikawa

Kita

et al. 2016

Molecular and Clinical Oncology

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Abstract. To the best of our knowledge, none of the prognostic staging systems for hepatocellular carcinoma (HCC) patients who underwent sorafenib therapy is universally adopted or preferred. In the present study, we aimed to compare prognostic ability among five prognostic systems, including the Japan Integrated Staging (JIS) system, the Barcelona Clinic Liver Cancer classification system, the tumor-node-metastasis classification system, the Cancer of the Liver Italian Program scoring system and the Chinese University Prognostic Index (CUPI) scoring system for HCC patients who received sorafenib therapy. A total of 143 HCC patients treated with sorafenib were analysed. We compared prognostic ability among the five prognostic systems using the likelihood ratio (LR) χ 2 test, linear trend χ 2 test and concordance index (c-index). Our cohort included 114 men and 29 women. The median patient age was 71 years (range, 45-89 years). A total of 102 patients were classified as Child-Pugh A and 41 as Child-Pugh B, whereas 31 patients (21.7%) had portal vein invasion and 63 (44.1%) extrahepatic metastases. The median survival time was 6.9 months. In the LR χ 2 test, the CUPI scoring system had the highest value (35.804), followed by the JIS system (17.469). In the linear trend χ 2 test, the CUPI scoring system had the highest value (17.523), followed by the JIS system (15.819). In addition, the JIS system had the highest value in the 6-month c-index (0.659) as well as in the 1-year c-index (0.674). However, the CUPI classification system had the lowest value in the 1-year c-index (0.590). In conclusion, the JIS system may be an appropriate staging system for HCC patients undergoing sorafenib therapy.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience

Endo

Nishikawa

Kita

et al. 2016

Molecular and Clinical Oncology

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“…1,[30][31][32] Although the BCLC system was validated as the most suitable prognostic system for patients with HCC in Italy and the United States, it was not considered a suitable prognostic system in the Eastern countries until now. 33,34 Furthermore, in the current study, surgical patients were excluded from the analysis, which may be an important reason that the BCLC system was inferior to the JIS system or the CLIP system in predicting the survival of patients with HCC.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Cho

Chung

Kim

et al. 2007

Cancer

110

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BACKGROUND.Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.METHODS.In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood‐ratio chi‐square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan‐Meier estimation and the log‐rank test.RESULTS.The 5‐year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (≤3.4 g/dL), the presence of ascites, serum α‐fetoprotein level (>60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.CONCLUSIONS.In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization. Cancer 2008. © 2007 American Cancer Society.

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“…Among patients who underwent localized CCRT according the above criteria, those who underwent 18 F-FDG-PET/CT before the initiation of treatment were included in the study. The modified International Union Against Cancer TNM staging system 21 and Barcelona Clinic Liver Cancer staging systems 22 were adopted.…”

Section: Patient Eligibilitymentioning

confidence: 99%

¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

Kim

Kang

Kim

et al. 2011

Cancer

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BACKGROUND: Metabolic activity assessed by 18 F-fluorodeoxyglocuse-positron emission tomography ( 18 F-FDG-PET) reflects biological aggressiveness and prognoses in various tumors. The authors present a correlation between tumor metabolic activity and clinical outcomes in patients with hepatocellular carcinoma (HCC). METHODS: Over a 3-year period (2005)(2006)(2007)(2008), 135 locally advanced HCC patients were treated with localized concurrent chemoradiotherapy (CCRT; external beam radiotherapy at 45 grays for 5 weeks plus concurrent hepatic arterial infusion of 5-fluorouracil during the first and fifth week) followed by repetitive hepatic arterial infusional chemotherapy with 5-fluorouracil and cisplatin. Among them, the authors studied 107 who received 18 F-FDG-PET before CCRT. Maximal standardized uptake values (SUVs) of tumors were calculated. RESULTS: The median maximal tumor SUV was 6.1 (range, 2.4-$19.2). Patients with low maximal tumor SUVs (<6.1) had a higher disease control rate than those with high maximal tumor SUVs (!6.1) (86.8% vs 68.5%, respectively, P ¼ .023). Both median progression-free survival (PFS; 8.4 vs 5.2 months; P ¼ .003) and overall survival (OS; 17.9 vs 11.3 months; P ¼ .013) were significantly longer in the low maximal tumor SUV group than in the high maximal tumor SUV group, respectively. In multivariate analysis, low maximal tumor SUV and objective responses to CCRT remained significant for PFS and OS. The high maximal tumor SUV group was more likely to have extrahepatic metastasis within 6 months than the low maximal tumor SUV group (58.1% vs 26.8%, respectively; P < .001). Similar results were obtained for the maximal tumor SUV/normal liver maximal SUV ratio (<2 vs !2) concerning progression, death, and extrahepatic metastasis. CONCLUSIONS: Metabolic activity may be useful not only in predicting prognosis and treatment responses, but also in establishing optimal treatment plans in locally advanced HCC. Cancer 2011;117:4779-

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Prospective validation of the Barcelona Clinic Liver Cancer staging system

Cited by 381 publications

References 39 publications

Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience

Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

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Prospective validation of the Barcelona Clinic Liver Cancer staging system

Cited by 381 publications

References 39 publications

Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience

Comparison of five staging systems in hepatocellular carcinoma treated with sorafenib: A single-center experience

Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

18F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

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¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma