Prognosis of hepatocellular carcinoma in relation to treatment across BCLC stages.
BACKGROUND
The Barcelona Clinic Liver Cancer (BCLC) staging system recommends first-line therapy for each tumor stage. We evaluated the effect of compliance with BCLC treatment allocation on the prognosis of patients with hepatocellular carcinoma (HCC).


METHODS
We retrospectively analyzed 359 consecutive, newly diagnosed HCC patients treated in our Liver Unit during a 14-year period. For each stage, survival was compared according to whether treatment matched the BCLC recommendation. We also compared the survival of patients in the same BCLC stage who received different treatments, and patients in different BCLC stages receiving the same treatment.


RESULTS
BCLC-A patients treated with radical therapies (66%) survived longer (117 vs. 20 months; p < 0.001) than patients (33%) who received locoregional or systemic therapies. Survival of BCLC-B patients treated with locoregional treatments (57%) was shorter (24 vs. 71 months; p < 0.001) than that of patients receiving radical therapies (32%). BCLC-C patients treated with systemic therapy or supportive care survived shorter (6 vs. 11 months; p = 0.003) than those receiving locoregional therapies (39%). Survival of BCLC-D patients receiving systemic therapies or supportive care was significantly lower than that of patients treated by liver transplantation (5 vs. 137 months; p < 0.001).


CONCLUSIONS
In addition to BCLC stage, actual treatment determines survival in patients with HCC.
Liver Unit, Clinica Universitaria de Navarra, Pamplona, Spain.
Delia
D
D'Avola
Mercedes
M
Iñarrairaegui
Fernando
F
Pardo
Fernando
F
Rotellar
Pablo
P
Marti
José I
JI
Bilbao
Antonio
A
Martinez-Cuesta
Alberto
A
Benito
Felix
F
Alegre
Erica
E
Mauleón
José I
JI
Herrero
Jorge
J
Quiroga
Jesus
J
Prieto
Bruno
B
Sangro
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate