Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2019; 11(9): 678-688
Published online Sep 27, 2019. doi: 10.4254/wjh.v11.i9.678
Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population
Laura Bainy Rodrigues de Freitas, Larisse Longo, Deivid Santos, Ivana Grivicich, Mário Reis Álvares-da-Silva
Laura Bainy Rodrigues de Freitas, Larisse Longo, Mário Reis Álvares-da-Silva, Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
Laura Bainy Rodrigues de Freitas, Larisse Longo, Mário Reis Álvares-da-Silva, Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
Deivid Santos, Mário Reis Álvares-da-Silva, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
Ivana Grivicich, Graduate Program in Health-Applied Cellular and Molecular Biology, ULBRA. Canoas, RS 92425-900, Brazil
Mário Reis Álvares-da-Silva, Department of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
Author contributions: de Freitas LBR and Longo L performed the majority of experiments and analyzed the data; Santos D performed clinical data collection; Grivicich I analysis and interpretation of data; Álvares-da-Silva MR designed and coordinated the research; de Freitas LBR, Longo L and Álvares-da-Silva MR wrote the manuscript; All the authors participated in the critical review and in the final approval of the manuscript.
Institutional review board statement: This study was approved by the Hospital de Clínicas de Porto Alegre Ethics Committee (CAAE 57899016.8.0000.5327) and followed recommended guidelines for studies of human subjects.
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/
Corresponding author: Laura Bainy Rodrigues de Freitas, MD, Medical Assistant, Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil. laurabrfreitas@gmail.com
Telephone: +55-51-981105083Fax: +55-51-33598760
Received: May 28, 2019
Peer-review started: May 29, 2019
First decision: June 13, 2019
Revised: July 8, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 27, 2019
Processing time: 122 Days and 6.3 Hours
Abstract
BACKGROUND

Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma (HCC) treatment, the Barcelona clinic liver cancer (BCLC) system has limitations, especially regarding intermediate-grade (BCLC-B) tumors. The recently proposed Hong Kong liver cancer (HKLC) staging system appears useful but requires validation in Western populations.

AIM

To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population, estimating the overall patient survival.

METHODS

This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016. Demographic, clinical, and laboratory data were collected. HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement. Overall survival was estimated based on the treatment proposed in each system.

RESULTS

A total of 519 HCC patients were assessed. Of these, 178 (34.3%) were HKLC-I; 95 (18.3%) HKLC-IIA; 47 (9.1%) HKLC-IIB; 29 (5.6%) HKLC-IIIA; 30 (5.8%) HKLC-IIIB; 75 (14.4%) HKLC-IV; and 65 (12.5%) HKLC-V. According to the BCLC, 25 (4.9%) were BCLC-0; 246 (47.4%) BCLC-A; 107 (20.6%) BCLC-B; 76 (14.6%) BCLC-C; and 65 (12.5%) BCLC-D. The general agreement between the two systems was 80.0% - BCLC-0 and HKLC-I (100%); BCLC-A and HKLC-I/HKLC-II (96.7%); BCLC-B and HKLC-III (46.7%); BCLC-C and HKLC-IV (98.7%); BCLC-D and HKLC-V (41.5%). When sub-classifying BCLC-A, HKLC-IIB, HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion, 13.4, 66.0, 100 and 36.7%, respectively, of the cases were classified as up-to-7 out.

CONCLUSION

In a Western population, the general agreement between the two systems was 80.0%, although in BCLC-B cases the agreement was low, suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC. The authors suggest that the BCLC system should be routinely employed, although for BCLC-B cases it should be associated with the HKLC system.

Keywords: Barcelona clinic liver cancer staging system; Hepatocellular carcinoma; Hong Kong liver cancer staging system

Core tip: Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma (HCC) treatment, the Barcelona clinic liver cancer (BCLC) system has limitation. Proposed Hong Kong liver cancer (HKLC) staging appears useful but requires validation in Western populations. This study showed that there is adequate agreement between the HKLC and BCLC systems regarding therapeutic management of HCC in Western populations, except in cases of intermediate HCC. Although staging systems should be further refined to cover the full diversity of HCC cases, these findings suggest that the BCLC system, which is more simple and intuitive, should be applied in all HCC cases, and that in BCLC-A and, especially, BCLC-B cases, the HKLC can contribute important information regarding patient management.