Validity of the Barcelona Clinic Liver Cancer and Hong Kong Liver Cancer staging systems for hepatocellular carcinoma in Singapore

Selby, L.K.; Tay, Rosanna X. Y.; Woon, Winston; Low, Jee Keem; Bei, Wang; Shelat, Vishal G; Pang, Tony; Junnarkar, Sameer P

doi:10.1002/jhbp.423

Cited by 24 publications

(14 citation statements)

References 12 publications

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“…This effectively increases the pool of HCC patients being considered for curative treatment under HKLC staging, who would otherwise not receive such an assignment by the BCLC algorithm. These findings are similar to a recent study conducted in a separate Singapore center, where 57.3% (439/766) of patients were classified by HKLC into stages I, II and Va, while only 38.5% (295/766) were classified by BCLC into stages 0 and A[14]. …”

Section: Discussionsupporting

confidence: 90%

“…Moreover, it was also not possible to tell if other co-morbidities precluded certain curative treatment options, for example a patient with significant pulmonary hypertension or valvular heart disease would be a high risk candidate for surgery but still have a good ECOG and Child-Pugh status at the time of diagnosis of HCC. This was also the conclusion in the study by Selby et al[14], where nearly half of the patients did not follow treatment recommendations by either staging system due to patients’ personal and physicians’ professional decision. Secondly, therapies have evolved and so have the techniques and experience of physicians, surgeons and interventional radiologists over the three decades of our HCC registry.…”

Section: Discussionsupporting

confidence: 76%

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Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

Li¹,

Goh²,

Chang³

et al. 2017

WJG

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AIMTo compare the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) classification systems when applied to HCC patients from the largest tertiary-level centre in Singapore.METHODSOne thousand two hundred and seventy hepatocellular carcinoma (HCC) patients prospectively enrolled in a tertiary-level centre registry in Singapore since 1988 were studied. Patients were grouped into their respective BCLC and HKLC stages. Data such as demography, aetiology of HCC and type of treatment were collected. Survival data was based on census with the National Registry of Births and Deaths on 31st October 2015. Statistical analyses were done using SPSS version 21 (Chicago, IL, United States). Survival analyses were done by the Kaplan-Meier method. Differences in survival rates were compared using the log-rank test.RESULTSThe median age at presentation was 63 years (range 13-94); male 82.4%; Chinese 89.4%, Malay 7.1%, Indian, 2.8%. Hepatitis B was the predominant aetiology (75.0%; Hepatitis C 7.2%, Hepatitis B and C co-infection 3.8%, non-viral 14.0%). Both BCLC and HKLC staging systems showed good separation with overall log rank test confirming significant survival differences between stages in our cohort (P < 0.001). 206 out of the 240 patients (85.8%) assigned for curative treatment by the BCLC treatment algorithm received curative therapy for HCC [Stage 0 93.2% (68/73); Stage A 82.6% (138/167)]. In contrast, only 341/558 (61.1%) patients received curative treatment despite being assigned for curative treatment by the HKLC treatment algorithm [Stage I 72.7% (264/363); Stage II 40.2% (66/164); Stage Va 35.5% (11/31)]. Patients who were assigned to curative treatment by HKLC but did not receive curative treatment had significantly poorer ECOG (P < 0.001), higher Child-Pugh status (P < 0.001) and were older (median age 66 vs 61, P < 0.001) than those who received curative therapy. Median overall survival in patients assigned to curative treatment groups by BCLC and HKLC were 6.1 and 2.6 years respectively (P < 0.001). When only patients receiving curative treatment were analyzed, BCLC still predicted overall median survival better than HKLC (7.1 years vs 5.5 years, P = 0.037).CONCLUSIONBCLC performs better than HKLC in our multiethnic Asian population in allocating patients to curative treatment in a real-life situation as well as in predicting survival.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 76%

Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

Li¹,

Goh²,

Chang³

et al. 2017

WJG

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“…Medical institutions should select a more suitable staging system for their HCC patients. 29 Except for FLR being an independent predictor of survival prognosis in HCC, some previous studies have found that larger tumor size (greater than 5 cm), higher TNM stage (stage III−Ⅳ), and microvascular invasion are all independent predictors for poor prognosis of HCC. In this study, these results have been verified again.…”

Section: Discussionmentioning

confidence: 95%

<p>Fibrinogen/Lymphocyte Count Ratio Can Be Used as a New Indicator of Prognosis in Patients with Hepatocellular Carcinoma After Radical Resection</p>

Yi-cheng¹,

Zheng-li²,

Deng³

et al. 2020

CMAR

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Preoperative fibrinogen levels are associated with the development, recurrence and metastasis of malignant tumors. This study was designed to investigate the clinical value of preoperative fibrinogen/lymphocyte count ratio (FLR) index in hepatocellular carcinoma (HCC). Patients and Methods: The clinical data of 479 patients with HCC who underwent radical resection were retrospectively analyzed. The correlation between FLR and clinicopathological features was analyzed by chi-square test or non-parametric test. The overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method. Results: The optimal cutoff value of FLR was determined as 1.6 according to the receiver operating characteristic curve (ROC) analysis, in order to predict prognosis for HCC patients after radical resection. It was further found that FLR level was correlated with tumor size, TNM stage, microvascular invasion and prognosis. Multivariate Cox regression analyses found that FLR was an independent predictor for postoperative OS (overall survival) (p = 0.002) and PFS (progression-free survival) (p = 0.001) in patients with HCC; and the 1-, 3and 5-year OS and PFS of HCC patients in the FLR ≤1.6 level group were significantly higher than those in the FLR >1.6 level group. Conclusion: Preoperative FLR level is a novel and effective predictor of prognosis in patients with HCC, and elevated FLR level is associated with poor prognosis in patients with HCC.

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“…Length of stay was calculated from the date of surgery to date of discharge, inclusive of both dates. Upon discharge, patients were followed with physical examination, liver function test, AFP, and multiphasic CT scan according to local protocol [17]. Site of recurrence was determined from clinical records and imaging.…”

Section: Methodsmentioning

confidence: 99%

“…All patients for liver resection received calf compressor devices, Bair hugger, low central venous pressure anesthesia, surgical infection prophylaxis, and intraoperative glycaemia monitoring according to our institutional policy [17, 18]. For open liver resections, a reverse “L” incision was made.…”

Section: Methodsmentioning

confidence: 99%

Preoperative Neutrophil-to-Lymphocyte Ratio Plus Platelet-to-Lymphocyte Ratio Predicts the Outcomes after Curative Resection for Hepatocellular Carcinoma

Kabir

Noor

et al. 2019

International Journal of Hepatology

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Background. In recent years, inflammation-based scoring systems have been reported to predict survival in Hepatocellular Carcinoma (HCC). The aim of our study was to validate combined preoperative Neutrophil-to-Lymphocyte ratio (NLR)-Platelet-to-Lymphocyte ratio (PLR) in predicting overall survival (OS) and recurrence free survival (RFS) in patients who underwent curative resection for HCC. Methods. We conducted a retrospective study of HCC patients underwent liver resection with curative intent from January 2010 to December 2013. Receiver-operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values for NLR and PLR. Patients with both NLR and PLR elevated were allocated a score of 2; patients showing one or neither of these indices elevated were accorded a score of 1 or 0, respectively. Results. 132 patients with a median age of 66 years (range 18-87) underwent curative resection for HCC. Overall morbidity was 30.3%, 30-day mortality was 2.3%, and 90-day mortality was 6.8%. At a median follow-up of 24 months (range 1-88), 25% patients died, and 40.9% had recurrence. On multivariate analysis, elevated preoperative NLR-PLR was predictive of both OS (HR 2.496; CI 1.156-5.389; p=0.020) and RFS (HR 1.917; CI 1.161-3.166; p=0.011). The 5-year OS was 76% for NLR-PLR=0 group, 21.7% for the NLR-PLR=1 group, and 61.1% for the NLR-PLR=2 group, respectively. The 5-year RFS was 39.3% for the NLR-PLR=0 group, 18.4% for the NLR-PLR=1 group, and 21.1% for the NLR-PLR=2 group, respectively. Conclusion. The preoperative NLR-PLR is predictive of both OS and RFS in patients with HCC undergoing curative liver resection.

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Validity of the Barcelona Clinic Liver Cancer and Hong Kong Liver Cancer staging systems for hepatocellular carcinoma in Singapore

Abstract: In our patient population, the HKLC system is comparable to the BCLC system in prognosticating patients, but is suggested to have better performance in guiding treatment.

Cited by 24 publications

References 12 publications

Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

<p>Fibrinogen/Lymphocyte Count Ratio Can Be Used as a New Indicator of Prognosis in Patients with Hepatocellular Carcinoma After Radical Resection</p>

Preoperative Neutrophil-to-Lymphocyte Ratio Plus Platelet-to-Lymphocyte Ratio Predicts the Outcomes after Curative Resection for Hepatocellular Carcinoma

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