title: Assessment of the Hong Kong Liver Cancer Staging System in Europe.
abstract: European and American guidelines have endorsed the Barcelona Clinic Liver Cancer (BCLC) staging system. The aim of this study was to assess the performance of the recently developed Hong Kong Liver Cancer (HKLC) classification as a staging system for hepatocellular carcinoma (HCC) in Europe.
  
  
  
  We used a pooled set of 1693 HCC patients combining three prospective European cohorts. Discrimination ability between the nine substages and five stages of the HKLC classification system was assessed. To evaluate the predictive power of the HKLC and BCLC staging systems on overall survival, Nagelkerke pseudo R2, Bayesian Information Criterion and Harrell's concordance index were calculated. The number of patients who would benefit from a curative therapy was assessed for both staging systems.
  
  
  
  The HKLC classification in nine substages shows suboptimal discrimination between the staging groups. The classification in five stages shows better discrimination between groups. However, the BCLC classification performs better than the HKLC classification in the ability to predict overall survival (OS). The HKLC treatment algorithm tags significantly more patients to curative therapy than the BCLC.
  
  
  
  The BCLC staging system performs better for European patients than the HKLC staging system in predicting OS. Twice more patients are eligible for a curative therapy with the HKLC algorithm; whether this translates in survival benefit remains to be investigated.
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.|University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Kolly
authors.affiliation: The Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.|The Liver Unit, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Reeves
authors.affiliation: Liver Unit, Clínica Universidad de Navarra and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, España.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.affiliation: University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland.
authors.forename: Marina
authors.initials: M
authors.lastname: Knöpfli
authors.affiliation: University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.|University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000145:classification* / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000145:classification* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: BCLC; HKLC; hepatocellular carcinoma; liver cancer; staging