Prospective validation of the Barcelona Clinic Liver Cancer staging system.
OBJECTIVE
The Barcelona Clinic Liver Cancer (BCLC) classification offers a prognostic stratification of patients with hepatocellular carcinoma (HCC). We recently demonstrated the BCLC's peculiar prognostic ability in a retrospective cohort of HCC patients. The aim of this study was to evaluate the BCLC system prospectively in a subsequent separate group of HCC patients enrolled at the same surgically oriented liver unit.


METHODS
One hundred and ninety-five consecutive HCC patients were prospectively enrolled and their liver disease was staged before therapy. Unlike the BCLC treatment protocol, nodule size and number were not used as absolute exclusion criteria for radical treatment. Predictors of survival were identified using the Cox model.


RESULTS
The median survival time was 23 months overall, and 53, 16, 7 and 3 months, respectively, for BCLC categories A, B, C, and D. In our cohort, BCLC had the best independent predictive power for survival when compared with the Okuda, CLIP, UNOS-TNM, and JIS prognostic systems (linear trend chi(2)=43.01, likelihood chi(2)=57.94, AIC 885.98). Moreover, the BCLC classification showed a better prognostic ability than the AJCC-TNM 2002 system in surgical patients.


CONCLUSIONS
The discriminating power of BCLC staging was prospectively assessed in an Italian cohort of HCC patients treated mainly with radical therapies.
Cillo
Umberto
U
Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, School of Medicine, University of Padua, Via Giustiniani 2, Policlinico III Piano, 35128 Padova, Italy.
Vitale
Alessandro
A
Grigoletto
Francesco
F
Farinati
Fabio
F
Brolese
Alberto
A
Zanus
Giacomo
G
Neri
Daniele
D
Boccagni
Patrizia
P
Srsen
Nela
N
D'Amico
Francesco
F
Ciarleglio
Francesco Antonio
FA
Bridda
Alessio
A
D'Amico
Davide Francesco
DF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D047368:Tumor Burden