Barcelona Clinic Liver Cancer staging system and survival of untreated hepatocellular carcinoma in a hepatitis B virus endemic area

Background and Aim: A uniform staging system for hepatocellular carcinoma (HCC) is needed. In this study, the discrimination abilities of HCC staging systems (American Joint Committee on Cancer [AJCC], Barcelona Clinic Liver Cancer [BCLC], Cancer of the Liver Italian Program, and Okuda stage) were compared during the course of untreated HCC. Methods: We included consecutive 80 patients diagnosed with HCC, but were not treated for HCC, at a single medical center in Korea. In addition, 177 treated patients matched by prognostic factors were included to evaluate the survival gain owing to locoregional treatment. Results: The mean age of untreated patients was 58.7 years. During the observation period (median=41.1 months), 72 patients died (median survival=2.1 months; range=1.6-33.7 months). Among various staging systems, the BCLC system had the best discrimination ability (linear trend χ²=16.35). Multivariate analysis indicated that the intrahepatic tumor classification (AJCC T classification) was an independent predictor of overall survival (OS) (P=0.001). However, either node or metastasis classification failed to affect the OS significantly (both P>0.05). Patients undergoing intrahepatic tumor control with locoregional therapy showed prolonged survival in those patients with nodal involvement (hazard ratio=0.315; P=0.004) and extrahepatic metastasis (hazard ratio=0.658; P=0.258), respectively, after adjustment for independent prognostic factors. Compared with untreated patients, BCLC stage A and B patients had >1 year of survival gain but those with stage C and D did not, owing to locoregional therapy. Conclusion: The BCLC system had the best discrimination among untreated HCC patients. However, re-evaluation of the clinical importance of nodal and metastasis classification might be required.