Dr Ronnie Poon and colleagues from Hong Kong developed a prognostic classification scheme with treatment guidance for Asian patients with hepatocellular carcinoma (HCC).
The research team collected data from 3856 patients with HCC predominantly related to hepatitis B treated at Queen Mary Hospital in Hong Kong from 1995 through 2008.
Data on patient performance status, Child–Pugh grade, tumor status, and presence of extrahepatic vascular invasion or metastasis were included, and randomly separated into training and test sets for analysis.
Cox regression and classification and regression tree analyses were used to account for the relative effects of factors in predicting overall survival times, and to classify disparate treatment decision rules, respectively.
The staging system and treatment recommendation then were constructed by integration of clinical judgments.
|The HKLC system was better able to distinguish between patients with specific overall survival times|
The research team compared the Hong Kong Liver Cancer (HKLC) classification with the Barcelona Clinic Liver Cancer (BCLC) classification in terms of discriminatory ability and effectiveness of treatment recommendation.
The team found that the HKLC system had significantly better ability than the BCLC system to distinguish between patients with specific overall survival times.
More importantly, HKLC identified subsets of BCLC intermediate- and advanced-stage patients for more aggressive treatments than what were recommended by the BCLC system, which improved survival outcomes.
Of BCLC-B patients classified as HKLC-II in our system, the team found that the survival benefit of radical therapies, compared with transarterial chemoembolization, was substantial.
In BCLC-C patients classified as HKLC-II, the survival benefit of radical therapies compared with systemic therapy was even more pronounced.
Dr Poon's team commented, "We collected data from patients with HCC in Hong Kong to create a system to identify patients who are suitable for more aggressive treatment than the currently used BCLC system."
"The HKLC system should be validated in non-Asian patient populations, and in patients with different etiologies of HCC."