Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7275-7284
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7275
Clinical values of Barcelona Clinic Liver Cancer subgroup and up-to-7 criteria in intermediate stage hepatocellular carcinoma with transcatheter arterial chemoembolization
Shou-Wu Lee, Yen-Chun Peng, Han-Chung Lien, Chung-Wang Ko, Chun-Fang Tung, Chi-Sen Chang
Shou-Wu Lee, Yen-Chun Peng, Han-Chung Lien, Chung-Wang Ko, Chun-Fang Tung, Chi-Sen Chang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Shou-Wu Lee, Yen-Chun Peng, Han-Chung Lien, Chung-Wang Ko, Chun-Fang Tung, Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
Shou-Wu Lee, Han-Chung Lien, Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung 40227, Taiwan
Shou-Wu Lee, Chi-Sen Chang, Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Author contributions: Lee SW, Peng YC and Chang CS designed the research study; Lee SW, Lien HC and Ko CW performed the research; Tung CF and Chang CS contributed new reagents and analytic tools; Lee SW, Lien HC and Tung CF analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by Institutional Review Board (No. 104DHA0500198).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shou-Wu Lee, MD, PhD, Assistant Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sec. 4, Taichung 40705, Taiwan. ericest@vghtc.gov.tw
Received: May 21, 2021
Peer-review started: May 21, 2021
First decision: June 27, 2021
Revised: June 28, 2021
Accepted: June 3, 2022
Article in press: June 3, 2022
Published online: July 26, 2022
Processing time: 415 Days and 23.6 Hours
ARTICLE HIGHLIGHTS
Research background

The widely used algorithm for the classification of hepatocellular carcinoma (HCC) is the Barcelona Clinic Liver Cancer (BCLC) staging system, based on tumor characteristics, like size, number, presence of macroscopic vascular invasion or extrahepatic spread as well as the hepatic function and performance status of the patient. The intermediate stage, or BCLC stage B, is characterized by the presence of large or multifocal HCC without evidence of macroscopic vascular invasion or extrahepatic spread. Transarterial chemoembolization (TACE) is the recommended treatment modality for these stage B patients. However, due to the clinical heterogeneity in this population of patients, only some have a favorable outcome after TACE.

Research motivation

The up-to-7 criteria, meaning the sum of the size of the largest tumor and the number of tumors within or beyond 7, is a practical standard to select those HCC patients for liver transplantation. This criteria was further proposed to identify which HCC patients in BCLC stage B could benefit from TACE.

Research objectives

The aim of the present study was to determine useful factors for predicting response to TACE and survival after TACE in patients with intermediate stage HCC.

Research methods

Patients with BCLC stage B HCC who underwent TACE as the primary treatment were enrolled at Taichung Veterans General Hospital from January 2005 to December 2009. Patients were assigned to either the objective responder (OR) group or the non-OR group according to mRECIST criteria. Clinical and radiological characteristics were compared between the 2 groups. The overall survival of enrolled subjects was analyzed.

Research results

In 128 enrolled patients, 66 (51.6%) were in the OR group and 62 (48.4%) in the non-OR group. Compared with the non-OR group, the OR group had a significantly smaller HCC size (6.55 cm vs 9.50 cm, P = 0.001) and was within the up-to-7 criteria (50% vs 26.7%, P = 0.001). After multivariable analyses, these significant associations still existed. Overall average survival rate of all the subjects was 20.65 ± 13.26 mo. Survival rates at 1-year were 64.8%, at 2-year were 46.9% and at 3-year were 31.2%. For those patients with OR to TACE, smaller tumor size and within up-to-7 criteria were associated with significantly better overall survival. Those patients with subgroup B1 had the highest OR ratio (75%) and better overall survival (26.70 ± 12.07 mo) after TACE.

Research conclusions

BCLC stage B HCC patients with smaller tumor size or within up-to-7 criteria had better survival outcomes to TACE. BCLC stage B subgroup is useful to predict refractoriness to TACE.

Research perspectives

In the future, the BCLC stage subgroup and up-to-7 criteria should have predictive value for patients with intermediate stage HCC receiving TACE.