THE VALIDATION OF HONG KONG LIVER CANCER STAGING SYSTEM AND COMPARISION WITH BARCELONA CLINIC LIVER CANCER FOR PREDICTION OF SURVIVAL AND TREATMENT IN HEPATOCELLULAR CARCINOMA PATIENTS

초록

Background and Aims: In addition to world widely endorsed BCLC system, various algorithms and staging systems were developed in many organizations, including the Hong Kong Liver Cancer (HKLC) staging. We validated the HKLC system and compared it with BCLC in HCC patients. Methods: The medical records of 875 HCC patients from 2004 to 2009 were retrospectively reviewed. The data including performance status, Child–Pugh score, tumor characteristics, treatment modality and survival were collected. Results: The etiology was predominantly chronic hepatitis B (CHB) (71.2%) and 90% of patients had child A and B liver function. Median follow up duration was 21.7 (0–178) months. Seventy-five percent of patients died during study period and median overall survival was 22.6 (0–181) months. The median overall survival was 45.44, 25.25, 21.25, 6.58, 3.19, 3.50, 3.00, 13.50 and 1.95 months in HKLC stage I, IIa, IIb, IIIa, IIIb, IVa, IVb, Va and Vb, respectively. Both HKLC and BCLC well differentiated the survival (p < 0.001). However, HKLC significantly well predicted 1 and 2 year of survival than BCLC (AUROC; 0.833 vs 0.801, p = 0.0027; 0.826 versus 0.799 in 2 year, p = 0.0144). In the patients in BCLC B and HKLC II, the curative therapy group recommended by HKLC showed better survival compared to TACE which recommended by BCLC (median overall survival; 55.57 vs. 28.22 months, p = 0.013). In BCLC B, the patients who treated according to HKLC showed better survival than who treated by BCLC (median overall survival; 45.34 vs. 31.00 months, p = 0.004). In BCLC subclass B1, the curative therapy was superior to TACE (median overall survival; 55.57 vs. 28.12 months, p = 0.038), while the differences were not significant in BCLC B2 and B3. In the patients in BCLC C and HKLC II, the curative therapy group recommended by HKLC showed better survival compared to systemic therapy which recommended by BCLC (median overall survival; 51.10 vs. 6.57 months, p < 0.001). Also, in BCLC C and HKLC III, the TACE group recommended by HKLC showed better survival compared to systemic therapy which recommended by BCLC (median overall survival; 15.78 vs. 5.87 months, p = 0.007). Conclusions: The HKLC system showed better survival compared to BCLC system in our population. The more individualized therapy could be considered by HKLC for management of HCC patients to improve prognosis.