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Published on: September 30, 2021
Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular
Thomas Yau1, Vikki Y F Tang2, Tzy-Jyun Yao3
1Department of Surgery and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
Insights
A new Hong Kong Liver Cancer (HKLC) classification system improves prognostic accuracy for Asian patients with hepatocellular carcinoma (HCC). It identifies candidates for more aggressive treatments, leading to significantly better survival outcomes compared to the Barcelona Clinic Liver Cancer (BCLC) system.
Area of Science:
- Hepatology
- Oncology
- Medical Classification Systems
Background:
- Hepatocellular carcinoma (HCC) is a major global health concern, particularly in Asia.
- Existing prognostic models like the Barcelona Clinic Liver Cancer (BCLC) system may not fully capture the nuances of HCC in Asian populations, especially those with hepatitis B-related disease.
- There is a need for a refined classification system that provides accurate prognostication and tailored treatment guidance for Asian HCC patients.
Purpose of the Study:
- To develop and validate a novel prognostic classification scheme for Asian patients diagnosed with hepatocellular carcinoma (HCC).
- To integrate treatment guidance within the new classification system to optimize patient management.
- To compare the performance of the developed system against the established Barcelona Clinic Liver Cancer (BCLC) classification.
Main Methods:
- Data from 3856 Hong Kong-based HCC patients, predominantly with hepatitis B, were analyzed.
- Cox regression and classification and regression tree analyses were employed to identify prognostic factors and treatment decision rules.
- The developed Hong Kong Liver Cancer (HKLC) classification was validated against the BCLC system using receiver operating characteristic curves and concordance indices.
Main Results:
- The HKLC system demonstrated superior discriminatory ability in predicting overall survival compared to the BCLC system (AUC 0.84 vs 0.80; C-index 0.74 vs 0.70).
- HKLC identified specific subgroups within BCLC intermediate (B) and advanced (C) stages who benefited from more aggressive therapies.
- Patients classified as HKLC-II within BCLC-B and BCLC-C stages showed substantial survival improvements with radical therapies over standard treatments (5-year survival: 52.1% vs 18.7% for BCLC-B; 48.6% vs 0.0% for BCLC-C).
Conclusions:
- The developed HKLC classification system offers improved prognostication and treatment guidance for Asian HCC patients.
- The HKLC system facilitates the identification of patients suitable for more aggressive treatment strategies, leading to enhanced survival.
- Further validation of the HKLC system in diverse non-Asian populations and HCC etiologies is warranted.
Background & Aims:
We aimed to develop a prognostic classification scheme with treatment guidance for Asian patients with hepatocellular carcinoma (HCC).
Methods:
We collected data from 3856 patients with HCC predominantly related to hepatitis B treated at Queen Mary Hospital in Hong Kong from January 1995 through December 2008. Data on patient performance status, Child-Pugh grade, tumor status (size, number of nodules, and presence of intrahepatic vascular invasion), and presence of extrahepatic vascular invasion or metastasis were included, and randomly separated into training and test sets for analysis. Cox regression and classification and regression tree analyses were used to account for the relative effects of factors in predicting overall survival times and to classify disparate treatment decision rules, respectively; the staging system and treatment recommendation then were constructed by integration of clinical judgments. The Hong Kong Liver Cancer (HKLC) classification was compared with the Barcelona Clinic Liver Cancer (BCLC) classification in terms of discriminatory ability and effectiveness of treatment recommendation.
Results:
The HKLC system had significantly better ability than the BCLC system to distinguish between patients with specific overall survival times (area under the receiver operating characteristic curve values, approximately 0.84 vs 0.80; concordance index, 0.74 vs 0.70). More importantly, HKLC identified subsets of BCLC intermediate- and advanced-stage patients for more aggressive treatments than what were recommended by the BCLC system, which improved survival outcomes. Of BCLC-B patients classified as HKLC-II in our system, the survival benefit of radical therapies, compared with transarterial chemoembolization, was substantial (5-year survival probability, 52.1% vs 18.7%; P < .0001). In BCLC-C patients classified as HKLC-II, the survival benefit of radical therapies compared with systemic therapy was even more pronounced (5-year survival probability, 48.6% vs 0.0%; P < .0001).
Conclusions:
We collected data from patients with HCC in Hong Kong to create a system to identify patients who are suitable for more aggressive treatment than the currently used BCLC system. The HKLC system should be validated in non-Asian patient populations and in patients with different etiologies of HCC.
