title: Validity of the Barcelona Clinic Liver Cancer and Hong Kong Liver Cancer staging systems for hepatocellular carcinoma in Singapore.
abstract: BACKGROUND
  Staging is vital in guiding therapeutic approach in patients diagnosed with hepatocellular carcinoma (HCC). Our study's goal is to compare paradigms in the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) systems, and evaluate the use of both in a local context, comparing their prognostic ability and therapeutic efficacy in the management of HCC.
  
  
  METHODS
  Seven hundred and sixty-six patients diagnosed between 2010 and 2015 were identified and staged according to BCLC and HKLC. Both system's performances were compared using Akaike information criterion (AIC), bootstrap concordance-index (c-index), and through Kaplan-Meier survival curves of patients who came under HKLC stages 1, 2, and 3 and the individual BCLC stages. Independent prognostic factors of survival were identified using univariate and multivariate analyses.
  
  
  RESULTS
  According to AIC and c-index, HKLC (AIC = 5,711, c-index = 0.74) has equivalent prognosticating value as BCLC (AIC = 5,764, c-index = 0.72). Through Kaplan-Meier curves, we determined that more aggressive treatments resulted in better outcomes. Particularly for patients under BCLC stage C, patients who followed the HKLC system's recommended treatments performed markedly better.
  
  
  CONCLUSIONS
  In our patient population, the HKLC system is comparable to the BCLC system in prognosticating patients, but is suggested to have better performance in guiding treatment.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Li Kim E
authors.initials: LK
authors.lastname: Selby
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Rosanna X Y
authors.initials: RX
authors.lastname: Tay
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Winston W L
authors.initials: WW
authors.lastname: Woon
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Jee Keem
authors.initials: JK
authors.lastname: Low
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Wang
authors.initials: W
authors.lastname: Bei
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Vishalkumar G
authors.initials: VG
authors.lastname: Shelat
authors.affiliation: Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: Tony C Y
authors.initials: TC
authors.lastname: Pang
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Sameer P
authors.initials: SP
authors.lastname: Junnarkar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D011379:Prognosis; D012846:Singapore / Q000453:epidemiology; D016019:Survival Analysis
keywords: Barcelona Clinic Liver Cancer system; Hepatocellular carcinoma; Hong Kong Liver Cancer system; Treatment strategy