Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2017; 23(22): 4054-4063
Published online Jun 14, 2017. doi: 10.3748/wjg.v23.i22.4054
Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective
James Weiquan Li, Boon-Bee George Goh, Pik-Eu Chang, Chee-Kiat Tan
James Weiquan Li, Boon-Bee George Goh, Pik-Eu Chang, Chee-Kiat Tan, Department of Gastroenterology and Hepatology, Singapore 169856, Singapore
Boon-Bee George Goh, Pik-Eu Chang, Chee-Kiat Tan, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
Author contributions: Li JW designed and performed the research and wrote the paper; Goh BBG performed the research, provided writing advice and supervised the paper; Chang PE provided writing advice and supervised the paper; Tan CK performed the research, helped with the writing of the manuscript and supervised the paper.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board (IRB), Singapore Health Services.
Informed consent statement: The IRB approved waiver of consent as the clinical data was anonymized prior to analysis and only aggregate data were reported. For patients who received therapy in this study, informed consent was obtained prior to therapy being performed.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chee-Kiat Tan, MBBS, MRCP, Associate Professor, Department of Gastroenterology and Hepatology, Level 3, Academia, 20 College Road, Singapore 169856, Singapore. tan.chee.kiat@singhealth.com.sg
Telephone: +65-62223322 Fax: +65-62273623
Received: January 15, 2017
Peer-review started: January 15, 2017
First decision: March 16, 2017
Revised: March 28, 2017
Accepted: May 9, 2017
Article in press: May 9, 2017
Published online: June 14, 2017
Processing time: 149 Days and 12.6 Hours
Abstract
AIM

To 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.

METHODS

One 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.

RESULTS

The 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).

CONCLUSION

BCLC 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.

Keywords: Hepatocellular carcinoma; Barcelona Clinic Liver Cancer; Hong Kong Liver Cancer; Staging systems; Prognosis; Survival

Core tip: This is a retrospective study of Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) staging systems when applied to a multiethnic Asian cohort, where Chinese ethnicity and hepatitis B aetiology are predominant. BCLC was more accurate in directing therapy, with a significantly higher proportion of patients assigned to curative therapy receiving the recommended curative treatment (85.8% vs 61.1%, P < 0.001). Median overall survival in patients assigned to curative therapy by the BCLC and HKLC staging systems was 6.1 and 2.6 years respectively (P < 0.001). Thus, overall, BCLC performed better than HKLC for staging our cohort of patients.