BCLC stage B is a better designation for single large hepatocellular carcinoma than BCLC stage A.
OBJECTIVE
Although the Barcelona Clinic Liver Cancer (BCLC) staging system is widely used for hepatocellular carcinoma (HCC) staging, the most appropriate BCLC stage designation for single large HCC (SLHCC, single nodule > 5 cm) remains controversial. This study investigated the prognosis of patients with SLHCC.


METHODS
Patients with newly diagnosed HCCs (BCLC stages A or B) were classified according to tumor burden: group 1, a single nodule > 2 and ≤ 5 cm or two or three nodules ≤ 3 cm; group 2, a single nodule > 5 cm; and group 3, two or three nodules > 3 cm or > 3 nodules. Survival analysis was performed according to tumor stage, treatment type, and Child-Pugh grade.


RESULTS
A total of 1005 patients were enrolled. Age was 59.3 ± 10.6 years, and 788 patients (78.4%) were men. Groups 1, 2, and 3 consisted of 613 (61.0%), 124 (12.3%), and 268 (26.7%) patients, respectively. HCC treatment included resection in 202 patients (20.1%), radiofrequency ablation ± transarterial chemoembolization in 311 patients (30.9%), and transarterial chemoembolization in 492 patients (49.0%). The median survival time differed significantly according to tumor stage (75.2, 44.9, and 30.3 months in groups 1, 2, and 3, respectively; P < 0.001). Multivariate analysis showed that group 2 had significantly worse survival compared with group 1 and similar survival to group 3.


CONCLUSIONS
Patients in group 2 had a worse prognosis than those in group 1 and a similar prognosis to those in group 3. Our results suggest that BCLC stage B is the best stage designation for SLHCC.
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Young Kul
YK
Jung
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Chang Ho
CH
Jung
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Yeon Seok
YS
Seo
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Ji Hoon
JH
Kim
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Tae Hyung
TH
Kim
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Yang Jae
YJ
Yoo
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Seong Hee
SH
Kang
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Sun Young
SY
Yim
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Sang Jun
SJ
Suh
Biostatistics, Korea University College of Medicine, Seoul, Korea.
Hyunggin
H
An
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Hyung Joon
HJ
Yim
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Jong Eun
JE
Yeon
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Kwan Soo
KS
Byun
Departments of Internal Medicine,, Korea University College of Medicine, Seoul, Korea.
Soon Ho
SH
Um
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
BCLC staging system; prognosis; single large hepatocellular carcinoma; treatment option