title: Validation of the BCLC prognostic system in surgical hepatocellular cancer patients.
abstract: OBJECTIVE
  Prognosis assessment in surgical patients with hepatocellular carcinoma (HCC) remains controversial. The most widely used HCC prognostic tool is the Barcelona Clinic Liver Cancer (BCLC) classification, but its prognostic ability in surgical patients has not been yet validated. The aim of this study was to investigate the value of known prognostic systems in 400 Italian HCC patients treated with radical surgical therapies.
  
  
  METHODS
  We analyzed a prospective database collection (400 surgical, 315 nonsurgical patients) observed at a single institution from 2000 and 2007. By using survival times as the only outcome measure (Kaplan-Meier method and Cox regression), the performance of the BCLC classification was compared with that of Okuda, Cancer of the Liver Italian Program, United Network for Organ sharing TNM, and Japan Integrated Staging Score staging systems.
  
  
  RESULTS
  Two hundred twenty-five patients underwent laparotomy resection; 55, laparoscopic procedures (ablation and/or resection); and 120, liver transplantations. In the surgical group, BCLC proved the best HCC prognostic system. Three-year survival rates of patients in BCLC Stages A, B, and C were 81%, 56%, and 44% respectively, (P < .01); whereas all other tested staging systems did not show significant stratification ability. When all 715 HCC patients were considered, surgery proved to be a significant survival predictor in each BCLC stage (A, B, and C).
  
  
  CONCLUSIONS
  BCLC staging showed the best interpretation of the survival distribution in a surgical HCC population. The BCLC treatment algorithm should consider the role of surgery also for intermediate-advanced stages of liver disease.
authors.affiliation: Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IRCCS, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vitale
authors.forename: E
authors.initials: E
authors.lastname: Saracino
authors.forename: P
authors.initials: P
authors.lastname: Boccagni
authors.forename: A
authors.initials: A
authors.lastname: Brolese
authors.forename: F
authors.initials: F
authors.lastname: D'Amico
authors.forename: E
authors.initials: E
authors.lastname: Gringeri
authors.forename: D
authors.initials: D
authors.lastname: Neri
authors.forename: N
authors.initials: N
authors.lastname: Srsen
authors.forename: M
authors.initials: M
authors.lastname: Valmasoni
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.forename: A
authors.initials: A
authors.lastname: Carraro
authors.forename: P
authors.initials: P
authors.lastname: Violi
authors.forename: A
authors.initials: A
authors.lastname: Pauletto
authors.forename: D
authors.initials: D
authors.lastname: Bassi
authors.forename: M
authors.initials: M
authors.lastname: Polacco
authors.forename: P
authors.initials: P
authors.lastname: Burra
authors.forename: F
authors.initials: F
authors.lastname: Farinati
authors.forename: P
authors.initials: P
authors.lastname: Feltracco
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.forename: D F
authors.initials: DF
authors.lastname: D'Amico
authors.forename: U
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult