title: Survival analysis of proposed BCLC-B subgroups in hepatocellular carcinoma patients.
abstract: OBJECTIVE
  The BCLC-staging system is used to facilitate treatment decisions in patients with hepatocellular carcinoma (HCC). Owing to the observed clinical heterogeneity of the intermediate stage BCLC-B, a subclassification was proposed taking Child-Pugh score and extended criteria for transplantation into account. Analysis of the prognostic significance of a proposed subclassification of the BCLC-B score in a European cohort of HCC patients.
  
  
  METHODS
  Eight hundred and eighty four consecutive HCC patients were retrospectively analysed. Patients with stage BCLC-B were grouped according to the proposed subclassification. Baseline patient and tumour characteristics, therapy and overall survival were analysed.
  
  
  RESULTS
  Two hundred and fifty four patients with stage BCLC-B were classified as B1/B2/B3 and B4 in 16.1/56.7/7.9 and 19.3%. OS compared between adjacent subgroups (B1 vs. B2, B2 vs. B3, B3 vs. B4) did not reach statistical significance. Groupwise comparison showed significant differences between B1 vs. B3 (P = 0.035), B1 vs. B4 (P = 0.006) and B2 vs. B4 (P < 0.0001). OS was significantly improved in patients undergoing OLT (P < 0.0001). Cox regression showed no significant influence of the BCLC-B substage on survival.
  
  
  CONCLUSIONS
  No significant survival differences between subgroups were found in the retrospective analysis. We could not confirm the BCLC-B subclassification to be prognostically meaningful in our cohort. As liver function and therapy influenced survival in this study, a more refined BCLC-B subclassification has the potential to be a useful tool to better stratify treatment decisions. Further studies in larger collectives with homogenous staging and treatment strategies are warranted to confirm the prognostic significance of the proposed subclassifications.
authors.affiliation: Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Weinmann
authors.forename: Sandra
authors.initials: S
authors.lastname: Koch
authors.forename: Martin
authors.initials: M
authors.lastname: Sprinzl
authors.forename: Roman
authors.initials: R
authors.lastname: Kloeckner
authors.forename: Henning
authors.initials: H
authors.lastname: Schulze-Bergkamen
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Wörns
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D005060:Europe; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis
keywords: BCLC; HCC; SIRT; TACE; epidemiology; hepatocellular carcinoma; liver transplantation; sorafenib; survival; therapy