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A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status
- Source :
- Gut and Liver
- Publication Year :
- 2018
-
Abstract
- Background/Aims Barcelona Clinic Liver Cancer (BCLC) C stage demonstrates considerable heterogeneity because it includes patients with either symptomatic tumors (performance status [PS], 1-2) or with an invasive tumoral pattern reflected by the presence of vascular invasion (VI) or extrahepatic spread (EHS). This study aimed to derive a more relevant staging system by modification of the BCLC system considering the prognostic implication of PS. Methods A total of 7,501 subjects who were registered in the Korean multicenter hepatocellular carcinoma (HCC) registry database from 2008 to 2013 were analyzed. The relative goodness-of-fit between staging systems was compared using the Akaike information criterion (AIC) and integrated area under the curve (IAUC). Three modified BCLC (m-BCLC) systems (#1, #2, and #3) were devised by reducing the role of PS. Results As a result, the BCLC C stage, which includes patients with PS 1-2 without VI/EHS, was reassigned to stage 0, A, or B according to their tumor burden in the m-BCLC #2 model. This model was identified as the most explanatory and desirable model for HCC staging by demonstrating the smallest AIC (AIC=70,088.01) and the largest IAUC (IAUC=0.722), while the original BCLC showed the largest AIC (AIC=70,697.17) and the smallest IAUC (IAUC=0.705). The m-BCLC #2 stage C was further subclassified into C1, C2, C3, and C4 according to the Child-Pugh score, PS, presence of EHS, and tumor extent. The C1 to C4 subgroups showed significantly different overall survival distribution between groups (p
- Subjects :
- Oncology
Male
Stage
medicine.medical_specialty
Carcinoma, Hepatocellular
Hepatocellular carcinoma
Tumor burden
03 medical and health sciences
0302 clinical medicine
Hepatitis B, Chronic
Internal medicine
Republic of Korea
medicine
Humans
Registries
Stage (cooking)
Staging system
Neoplasm Staging
Hepatology
Performance status
business.industry
Liver Neoplasms
Gastroenterology
Area under the curve
Hepatitis C, Chronic
Middle Aged
medicine.disease
Prognosis
Survival Analysis
Tumor Burden
Eastern Cooperative Oncology Group performance status
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
Original Article
Akaike information criterion
Liver cancer
business
Barcelona Clinic Liver Cancer Staging
Subjects
Details
- ISSN :
- 20051212
- Volume :
- 13
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Gut and liver
- Accession number :
- edsair.doi.dedup.....6d9cc7024a11b4a33379fa109550574d