Validity of the Barcelona clinic liver cancer (BCLC) and Hong Kong liver cancer (HKLC) staging system in determining treatment for hepatocellular carcinoma (HCC) in Singapore

Abstract

Various staging systems have been introduced to stage and guide the therapeutic approach in patients diagnosed with HCC. The goal of our study is to compare paradigms in the HCC staging system, specifically, the BCLC and HKLC system, and to ultimately determine which framework Tan Tock Seng Hospital (TTSH), Singapore, employs more often. Generally, the HKLC algorithm provides a more refined staging and offers more aggressive treatments than the BCLC algorithm. A retrospective analysis was done, in which patients diagnosed with HCC at TTSH between 2010 and 2015 were identified and staged according to both the BCLC and HKLC staging system. The offered treatment was recorded and compared against the recommended treatment algorithm corresponding to each staging framework. Through this comparison, we determined which algorithm was followed by the hospital, if any at all. 779 patients were identified and in 475 (60.8%) cases, either the BCLC or HKLC was followed. 155 (19.9%) patients exclusively used the treatment algorithm recommended by HKLC while 78 (10.0%) patients exclusively followed the treatment algorithm recommended by BCLC. In the cases that exclusively followed the HKLC system, more aggressive treatments were offered than if the BCLC algorithm had been followed instead. In 242 (31.1%) cases, both algorithms recommend the same treatment modality and hence, these patients followed both staging systems. Finally, the treatment offered to 304 (39.0%) patients did not correspond to either of the staging systems. In general, the HKLC staging system was adopted by the hospital in a higher percentage of cases.