title: Hepatocellular Carcinoma Patients With Performance Status 1 Deserve New Classification and Treatment Algorithm in the BCLC System.
abstract: Hepatocellular carcinoma (HCC) patients with performance status (PS) 1 or 2 are considered similar in the Barcelona Clinic Liver Cancer (BCLC) system. The rationales are not fully studied. A total of 693 and 335 HCC patients were classified as PS 1 and 2, respectively, in a prospectively followed up database. One-to-one matched pairs between HCC patients were generated by using the propensity score with matching model. Survival analysis was performed and the hazard ratio was calculated with the Cox proportional hazards model. Patients with PS 1 were significantly younger and had better liver and renal functions compared with patients with PS 2 (all P < 0.05). Patients with PS 1 had earlier BCLC stages and higher chances to undergo curative treatments (both P < 0.05). After matching, patients with PS 1 or 2 had similar age, gender, liver diseases, severity of cirrhosis, tumor burden, and treatments (all P > 0.05); patients with PS 1 had significantly better prognosis compared with patients with PS 2 (P < 0.05). There were 68% of patients with PS 1 that underwent aggressive treatments (resection, transplantation, percutaneous ablation, or transarterial chemoembolization), which were significantly correlated to better outcome with a hazard ratio of 0.539 in the matching model (P = 0.002). For patients with PS 2, aggressive treatments were not significantly associated with better long-term survival. Aggressive treatments provide survival benefits for patients with PS 1, but not for patients with PS 2. HCC patients with PS 1 or 2 should be considered clinically different disease entities in the BCLC system.
authors.affiliation: From the Department of Medicine (C-YH, P-HL, Y-HL, Y-HH, H-CL, T-IH); Department of Surgery (C-YH); and Department of Radiology (Y-YC), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine (C-YH, P-HL, Y-HL, C-YH, Y-YC, H-CL, T-IH); Institute of Clinical Medicine (Y-HH); Institute of Pharmacology, National Yang Ming University School of Medicine (T-IH) and Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV (C-YH).
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Po-Hong
authors.initials: PH
authors.lastname: Liu
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis