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BCLC-B Subclassification and the Hong Kong Liver Cancer System in Intermediate Hepatocellular Carcinoma

Identifying Candidates for Curative Therapy

Longo, Larisse, BSc, PhD*,†; Rodrigues de Freitas, Laura B., MD*,‡,§; Santos, Deivid, MD§,∥; Grivicich, Ivana, BSc, PhD‡,¶; Álvares-da-Silva, Mário R., MD, PhD*,†,§,∥

American Journal of Clinical Oncology: May 2019 - Volume 42 - Issue 5 - p 466–471
doi: 10.1097/COC.0000000000000539
Original Articles: Gastrointestinal

Introduction: The intermediate stage of the Barcelona Clinic Liver Cancer (BCLC) classification includes a heterogenous population of patients with hepatocellular carcinoma (HCC), and palliative treatment with transarterial chemoembolization is recommended for all of them. In this regard, 2 other classifications could be useful, the subclassification BCLC-B (SUB) and the classification Hong Kong Liver Cancer (HKLC).

Objective: To determine the indication of curative or palliative treatment between SUB and HKLC in BCLC-B patients.

Patients and Methods: A retrospective study in HCC patients seen between 2011 and 2016 in southern Brazil. Demographic, clinical, and laboratory data were collected. HCC staging was performed with BCLC, SUB, and HKLC.

Results: A total of 570 patients with HCC were assessed, of whom 95 were classified as BCLC-B: 25 (26.0%) B1, 48 (50.5%) B2, 9 (9.5%) B3, and 13 (13.7%) B4. Overall median survival was 21.1 (95% confidence interval, 14.2-28.0) months. Median survival was higher for BCLC-B1 patients than in subgroups B3 (P=0.046) and B4 (P=0.001), and this was also seen for B2 versus B4 (P=0.044). Regarding the HKLC classification, a significantly higher median survival was observed for HKLC-I and HKLC-IIB in relation to the categories HKLC-IIIA (P<0.001 and 0.004, respectively) and HKLC-IIIB (P<0.001 and 0.006, respectively). When HKLC was applied, the following were identified as candidates for curative treatment: BCLC-B1, 24 (96.0%); BCLC-B2, 26 (54.2%); BCLC-B3, 0 (0%); and BCLC-B4, 3 (23.1%).

Conclusion: In intermediate HCC, SUB was able to identify a subset of patients with a higher overall survival. According to HKLC, 55.8% of BCLC-B patients could receive curative treatment.

*Graduate Program in Gastroenterology and Hepatology

School of Medicine, Universidade Federal do Rio Grande do Sul

Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre

§Department of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre

School of Medicine

Graduate Program in Health-Applied Cellular and Molecular Biology, ULBRA, Canoas, Brazil

The authors declare no conflicts of interest.

Reprints: Larisse Longo, BSc, PhD, Serviço de Gastroenterologia do Hospital de Clínicas de Porto Alegre. Rua Ramiro Barcelos, no. 2350/ sala 2033, 2° andar. CEP 90035-903, Bairro Santana, Porto Alegre, Rio Grande do Sul (RS), Brazil. E-mail:

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