Diagnostic and therapeutic approaches to hepatocellular carcinoma. The classification takes the following variables into account 1,2. We aimed to compare the prognostic accuracy of the hong kong liver cancer staging hklc, the model to estimate survival for hcc mesh, and the bclc staging systems using a western cohort of hcc patients. Among them, only the barcelona clinic liver cancer bclc and hong kong liver cancer hklc staging systems also recommend treatment modality. Staging of hepatocellular carcinoma, hepatology 10. The treatment chosen depends upon how much the cancer has. Validation of prognostic accuracy of mesh, hklc, and bclc. Patients with barcelona clinic liver cancer stages b and c. Image reproduced with permission reproduced with permission of the american association for the study of liver diseases, from bruix j and sherman m 2011, management of hepatocellular carcinoma. Aug 11, 2017 a total of 8%, 24%, 16%, 39%, and 12% of patients were classified as bclc stages 0, a, b, c, and d, respectively at the time of diagnosis. The barcelona clinic liver cancer bclc system has been extensively validated and is the most commonly used staging system for hcc.
If you have enrolled in bclcs voluntary selfexclusion program please refrain from taking this survey. A total of 8%, 24%, 16%, 39%, and 12% of patients were classified as bclc stages 0, a, b, c, and d, respectively at the time of diagnosis. The barcelonaclinic liver cancer bclc approach to hepatocellular carcinoma management. Moreover, the auc of the eastern staging is higher at each time. Hepatocellular carcinoma hcc is an aggressive tumor that frequently occurs in the setting of chronic liver disease and cirrhosis see epidemiology and etiologic associations of hepatocellular carcinoma. The bclc staging system looks at the number and size of tumours in the liver and at how well you are overall your performance status ps, as well as your liver function. Their staging validation, however, is limited by critical shortcomings. Different survival of barcelona clinic liver cancer stage. Staging and prognostic factors in hepatocellular carcinoma. Introduction several hepatocellular carcinoma hcc staging systems are available. The bclc system links each tumor stage with appropriate therapeutic interventions in a guideline format fig 4. Image reproduced with permission reproduced with permission of the. Bclc barcelona clinic liver cancer clinic barcelona hospital universitari villarroel, 170 08036 barcelona t.
Barcelona clinic liver cancer bclc staging uses a set of criteria to guide the management of patients with hepatocellular carcinoma hcc. Hepatic resection hr is the treatment of choice for hcc in noncirrhotic patients. Liver cancer bclc staging radiology reference article. Apr 17, 2015 barcelona clinic liver cancer bclc staging 1. Rads, the bclc staging system advocated by the aasld, and the tnm system.
Patient survival was better when patients received the recommended treatment in stages 0 or a. Talk to your doctor if you have questions about staging. Jcm free fulltext predictive effects of inflammatory. Jan 27, 2009 a consensus on the most reliable staging system for hepatocellular carcinoma hcc is still lacking but the most used is a revised barcelona clinic liver cancer bclc system, adopted by the american association for the study of liver diseases aasld. State of the art key messages bclc staging system is recommended for prognostic prediction and treatment allocation and mrecist is the best method to classify treatment response molecular classification of hcc based on gene signatures or molecular abnormalities is not ready for clinical application. What is the barcelona clinic liver cancer bclc staging. As described in the bclc guidelines, this stratum of patients shows a survival benefit from tace, which will be discussed later. We summarize the bclc staging system and treatment strategies for each disease stage in figure 1. Barcelona clinic liver cancer bclc classification for. However, only 7% of patients were initially treated with sorafenib in this study, due to the late introduction of sorafenib, high costs and strict medical reimbursement.
This study was performed to investigate the prognostic factors for. Hepatocellular cancer hcc accounts for 47,000 deaths per year in europe and the incidence is expected to increase over the next 1015 years. Staging and restaging for hepatocellular carcinoma. A number of staging systems have been proposed but, in europe, the most widely used is the barcelonaclinic liver cancer bclc classification. The barcelona clinic liver cancer bclc staging system is widely used to classify hepatocellular carcinoma hcc.
The eastern staging system provides the highest likelihood ratio according to the. Pdf hepatocellular carcinoma hcc is a major health problem with a high. Because imaging is the primary means for diagnosis and staging of hepatocellular carci noma, radiologists require a systematic approach to perform this task with appropriate accuracy and precision. Dec 29, 2018 staging of hepatocellular carcinoma hcc is necessary for guiding prognostication, management, and research purposes that further aid in the improvement of existing clinical and epidemiological health services. On the right side, the two treatments are combined into one box. The bclc algorithm prescribes palliative therapies ablation.
The japan integrated staging jis score was published in 2003 table 318. Cancer staging systems are important for identification of appropriate therapies and prediction of prognosis for individual patients. Pdf on sep 26, 2018, sedat karademir and others published staging of. It is typically diagnosed late in the course of these diseases, and the median survival following diagnosis ranges from approximately 6 to 20 months. Mar 27, 2015 the eastern staging system provides the highest likelihood ratio according to the. The barcelonaclinic liver cancer bclc staging system 4,8,11 was constructed on the basis of the results obtained in the setting of several cohort studies and rcts by the barcelona group. The bclc algorithm prescribes palliative therapies ablation, chemoembolization. Multiple staging systems have been proposed and generally claimed to have better prognostic performance. A new treatmentintegrated prognostic nomogram of the. This proposal is not a scoring system as it derives from the identification of independent prognostic factors in the setting of several studies, conforming a staging classification. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Considering the increasing importance of immune checkpoints in tumor immunity we investigated the clinical relevance of serum tcell immunoglobulin and mucin domain3 tim3 in patients with hepatocellular carcinoma hcc.
The bclc staging classification for hcc is currently the only staging system that includes an integrated assessment of liver disease, tumor extension, and presence of constitutional symptoms, providing in the meantime an indication of the firstline treatment. Barcelona clinic liver cancer bclc staging for hepatocellular carcinoma. Apr 16, 2018 the bclc staging system is developed from the results obtained in the setting of several cohort studies and rcts 1,3,28. Lotto winning numbers 649, lotto max and more bclc. Bclc staging system, which links cancer stag ing with treatment options. A bclc stage of 0 defined as very early stage disease comprises. Sirt c iii, c c nonstandard, alternative treatment. Bclc staging system and the childpugh system liver. We investigated how many patients are diagnosed in very early and early stage, follow the aasld guidelines for treatment and whether their. Feb 21, 2018 the barcelona clinic liver cancer bclc staging system for hepatocellular carcinoma. Jun 26, 2018 the bclc staging system for hcc has been widely adopted and is curiously highlighted in the corresponding journal of clinical oncology podcast accompanying the report by rajyaguru et al. The recommended treatment algorithms of the bclc and hklc. Though there are some new staging systems for hcc developed in different parts of the world, there is no globally accepted staging system that allows for comparison of.
To evaluate the predictive power of the hklc and bclc staging systems on overall survival. Model to estimate survival in ambulatory patients with hepatocellular carcinoma. Staging is a term used to describe how far a particular cancer has spread. In our cohort, bclc had the best independent predictive power for survival when compared with the okuda, clip, unostnm, and jis prognostic systems linear trend. Barcelona clinic liver cancer stage b hepatocellular.
The lack of consensus may result from the heterogeneous nature of tumor biology and variable treatment strategies at initial staging and restaging. Despite intensive surveillance programs, considerable recent therapeutic advances and use of potentially radical treatments, prognosis and life. This study was designed to see whether bclc and hklc staging can guide treatment strategy, so analyzed whether patients survival is better for those who received recommended therapy by each staging system. The bclc staging system for hcc has been widely adopted and is curiously highlighted in the corresponding journal of clinical oncology podcast accompanying the report by rajyaguru et al. Bclc staging system and tace according to the bclc system, tace is the standard of care for both intermediate hcc. There are a number of different systems used to stage liver cancer.
Adapted from llovet jm, fuster j, bruix j, barcelonaclinic liver cancer group. The bclc system links each tumor stage with appropriate therapeutic interventions in. Bclc includes predictors of prognosis in hcc patients including tumor. The bclc staging system is the only staging system used for hcc that has a therapeutic algorithm. Though there are some new staging systems for hcc developed in different parts of the world, there is no globally accepted staging system that allows for comparison of current. In addition to the tnm staging for hcc, other systems have been proposed to help guide therapeutic strategies. The staging of tumors was determined according to the bclc staging classification. Association of provider specialty and multidisciplinary care. Serum tim3 levels were measured and their association with hcc stage and the detection of serum programmed death ligand1 pdl1 were assessed. In cirrhotics, the best candidates for hr are those with a single lesion with a very wellpreserved liver function.
The most widely used staging system used is the barcelonaclinic liver cancer bclc classification according to which, 3040% patients. Comparing staging systems for predicting prognosis and. Survival analyses are flawed when neglecting barcelona clinic. The barcelona clinic liver cancer bclc staging system for hepatocellular carcinoma. There are 5 stages stage 0 followed by stages a, b, c and d.
Patients with a single nodule up to 50 mm or up to three nodules, the largest being up to 30 mm if your referral liver transplant center uses milan criteria, or the sum. The barcelona clinic liver cancer bclc intermediate and. Most people who get liver cancer hepatic cancer get it in the setting of chronic liver disease incidence rates of hepatocellular cancer are rising in the united states due to increasing prevalence of cirrhosis caused by chronic hepatitis c and nonalcoholic fatty liver disease there are many treatment alternatives for liver cancer. The bclc staging system is developed from the results obtained in the setting of several cohort studies and rcts 1,3,28. Different survival of barcelona clinic liver cancer stage c. One of these validated systems is the barcelonaclinic liver cancer staging system bclc.
Letter to the editor volume 62, issue 2, p492493, february 01, 2015. The bclc system is used in most major trials of hepatocellular carcinoma interventions, making it the reference staging system, and it is continuously updated to incorporate emerging changes 22,23. Hong kong liver cancer staging system is associated with bet. Barcelona clinic liver cancer bclc classification for ios.
Hepatocellular carcinoma hcc has an increasing incidence worldwide, and it is the leading cause of death in patients with cirrhosis. The bclc system incorporates characteristics of the tumor, the background liver function and also the patients performance status. It is the fifth most common cancer and the third most common cause of cancerrelated death. As it is not based on identification of prognostic factors from a regression analysis, bclc is not able to predict the mortality in hcc patients 26. Barcelona clinic liver cancer bclc staging is a classification and treatment algorithm for hepatocellular carcinoma based on tumor characteristics and extent, performance status, stage of liver. The incidence of hepatocellular carcinoma hcc and associated mortality have been steadily on the rise.