Abstract
Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients’ survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related mortality worldwide [1]
There are several staging system proposed for HCC, but the Barcelona Clinic Liver Cancer (BCLC) staging system is unique among the other staging systems used for HCC that each stage simultaneously links treatment strategy [3]
In the study by Choi et al, transarterial chemoembolization (TACE) plus sorafenib was superior to sorafenib alone in patients with advanced HCC [13]. These findings indicate that advanced stage (BCLC stage C) includes a heterogeneous population that optimal treatment modality may not be sorafenib monotherapy for some patients
Summary
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related mortality worldwide [1]. Many factors are associated with survival of patients with HCC, and selection of optimal treatment strategy can improve patient survival [2]. Sub-Staging of BCLC C should consider the size and number of the tumor, tumor location, anatomical considerations, and liver functions [2]. Tumor staging is intended to help estimate patients prognosis and guide decision making for treatment [3]. There are several staging system proposed for HCC, but the Barcelona Clinic Liver Cancer (BCLC) staging system is unique among the other staging systems used for HCC that each stage simultaneously links treatment strategy [3]
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