title: The recommended treatment algorithms of the BCLC and HKLC staging systems: does following these always improve survival rates for HCC patients?
abstract: Several staging systems have been proposed for hepatocellular carcinoma (HCC). Among them, only the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) staging systems also recommend treatment modality. This study was designed to see whether BCLC and HKLC staging can guide treatment strategy, so analyzed whether patients survival is better for those who received recommended therapy by each staging system.
  
  
  
  A total of 3515 treatment-naïve, newly diagnosed HCC patients at a single centre were analyzed.
  
  
  
  Five-year survival rates according to BCLC stages: 0 = 79.1%, A = 62.9%, B = 40.3%, C = 21.3% and D = 27.0%; 5-year survival rates according to HKLC stages: I = 72.3%, IIa = 54.9%, IIb = 50.6%, IIIa = 21.3%, IIIb = 10.2%, IVa = 16.7%, IVb = 7.2%, Va = 47.1% and Vb = 11.3%. The C-indices of the BCLC and HKLC staging systems were 0.708 and 0.732 respectively. Patient survival was better when patients received the recommended treatment in stages 0 or A; survival was worse if treatment began at stage B, C or D. For HKLC staging system, survival was better when patients received the recommended treatment in stages I, IIa, IIb, IIIa or Va but was worse when treatment began in stages IIIb, IVa, IVb or Vb.
  
  
  
  Both the BCLC and HKLC staging systems effectively stratified patient prognosis, but neither could direct therapy for a large proportion of patients; for some stages, recommended therapy was associated with worse prognosis.
authors.affiliation: Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
authors.forename: Kwang Min
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.affiliation: Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea.
authors.forename: Sin-Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yong-Han
authors.initials: YH
authors.lastname: Paik
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Joon Hyeok
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. sw.paik@samsung.com.
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
mesh_terms: D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Barcelona Clinic Liver Cancer; Hong Kong Liver Cancer; Stage; hepatocellular carcinoma