title: External validation of a simplified BCLC staging system for early hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim was to externally validate the capability of a simplified Barcelona Clinic Liver Cancer (s-BCLC) staging system in allocating patients to hepatic resection (HR) and the effect on survival: S-BCLC was defined by only 2 groups: AA included BCLC A1 + A2 classes with alpha-fetoprotein (AFP) ≤ 20 ng/ml and AB included A1 + A2 with AFP > 20 ng/ml plus A3 + A4 subgroups.
  
  
  METHODS
  This study compared a training group (TG) with hepatocellular carcinoma (HCC) submitted to hepatic resection (HR) in Milan with another group of patients, the validation group (VG) in Creteil. All patients underwent ultrasound-guided anatomical resection (<3 segments).
  
  
  RESULTS
  Overall survival got worse from A1 to A4 (p = 0.0271) in TG (n = 132), as well as in VG (n = 100) (p = 0.0044) with a more important overlapping of each curves. According s-BCLC classification, the survival curves of TG (p = 0.0001) and VG (p = 0.0250) showed a definitive separation in two different staging groups. The s-BCLC provided the best predictive accuracy and it also presented the highest separability index and C-statistics in both TG and VG. On the other hand, in the evaluation of discriminatory ability for death, measured by ROC curve areas, the s-BCLC system gave better results than the others.
  
  
  CONCLUSIONS
  This experience stressed the high value of BCLC system in staging of HCC, but the s-BCLC system seems to be more useful for therapeutic decision making.
authors.affiliation: Chirurgia 2 - Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, Italy. rsantambrogio@mclink.it
authors.forename: R
authors.initials: R
authors.lastname: Santambrogio
authors.forename: J
authors.initials: J
authors.lastname: Salceda
authors.forename: M
authors.initials: M
authors.lastname: Costa
authors.forename: M D
authors.initials: MD
authors.lastname: Kluger
authors.forename: M
authors.initials: M
authors.lastname: Barabino
authors.forename: A
authors.initials: A
authors.lastname: Laurent
authors.forename: E
authors.initials: E
authors.lastname: Opocher
authors.forename: D
authors.initials: D
authors.lastname: Azoulay
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods / Q000401:mortality*; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: AASLD; AFP; American Association for the Study of Liver Diseases; BCLC; Barcelona Clinic Liver Cancer; HCC; HR; Hepatic resection; Hepato-Pancreato-Biliary Association; Hepatocellular carcinoma; IHPBA; IOUS; LCSGJ; Laparoscopy; Liver Cancer Study Group of Japan; Liver cancer; Liver cirrhosis; Radiofrequency ablation; Staging system; TG; Training group; VG; Validation group; alpha-fetoprotein; hepatic resection; hepatocellular carcinoma; intraoperative ultrasonography; s-BCLC; simplified system for BCLC stage A