The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Kuan Chieh Fang, Wei Yu Kao, Chien Wei Su, Po Chun Chen, Pei Chang Lee, Yi Hsiang Huang, Teh Ia Huo, Chun Chao Chang, Ming Chih Hou, Han Chieh Lin, Jaw Ching Wu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

Original languageEnglish
Pages (from-to)335-358
Number of pages24
JournalLiver Cancer
Volume7
Issue number4
DOIs
Publication statusPublished - Oct 1 2018

Fingerprint

Liver Neoplasms
Bilirubin
Albumins
Hepatocellular Carcinoma
Survival Rate
alpha-Fetoproteins
Therapeutics
Alkaline Phosphatase
Creatinine
Multivariate Analysis

Keywords

  • Barcelona Clinic Liver Cancer stage
  • Hepatocellular carcinoma
  • Prognosis
  • Staging
  • Tumor size

ASJC Scopus subject areas

  • Hepatology
  • Oncology

Cite this

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B : The Role of Albumin-Bilirubin Grade. / Fang, Kuan Chieh; Kao, Wei Yu; Su, Chien Wei; Chen, Po Chun; Lee, Pei Chang; Huang, Yi Hsiang; Huo, Teh Ia; Chang, Chun Chao; Hou, Ming Chih; Lin, Han Chieh; Wu, Jaw Ching.

In: Liver Cancer, Vol. 7, No. 4, 01.10.2018, p. 335-358.

Research output: Contribution to journalArticle

Fang, Kuan Chieh ; Kao, Wei Yu ; Su, Chien Wei ; Chen, Po Chun ; Lee, Pei Chang ; Huang, Yi Hsiang ; Huo, Teh Ia ; Chang, Chun Chao ; Hou, Ming Chih ; Lin, Han Chieh ; Wu, Jaw Ching. / The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B : The Role of Albumin-Bilirubin Grade. In: Liver Cancer. 2018 ; Vol. 7, No. 4. pp. 335-358.
@article{7c66bcb05bfd4aac992c0c6fdf0bffdd,
title = "The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade",
abstract = "Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3{\%} for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.",
keywords = "Barcelona Clinic Liver Cancer stage, Hepatocellular carcinoma, Prognosis, Staging, Tumor size",
author = "Fang, {Kuan Chieh} and Kao, {Wei Yu} and Su, {Chien Wei} and Chen, {Po Chun} and Lee, {Pei Chang} and Huang, {Yi Hsiang} and Huo, {Teh Ia} and Chang, {Chun Chao} and Hou, {Ming Chih} and Lin, {Han Chieh} and Wu, {Jaw Ching}",
year = "2018",
month = "10",
day = "1",
doi = "10.1159/000487407",
language = "English",
volume = "7",
pages = "335--358",
journal = "Liver Cancer",
issn = "2235-1795",
publisher = "S. Karger AG",
number = "4",

}

TY - JOUR

T1 - The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B

T2 - The Role of Albumin-Bilirubin Grade

AU - Fang, Kuan Chieh

AU - Kao, Wei Yu

AU - Su, Chien Wei

AU - Chen, Po Chun

AU - Lee, Pei Chang

AU - Huang, Yi Hsiang

AU - Huo, Teh Ia

AU - Chang, Chun Chao

AU - Hou, Ming Chih

AU - Lin, Han Chieh

AU - Wu, Jaw Ching

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

AB - Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

KW - Barcelona Clinic Liver Cancer stage

KW - Hepatocellular carcinoma

KW - Prognosis

KW - Staging

KW - Tumor size

UR - http://www.scopus.com/inward/record.url?scp=85044076637&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044076637&partnerID=8YFLogxK

U2 - 10.1159/000487407

DO - 10.1159/000487407

M3 - Article

C2 - 30488023

AN - SCOPUS:85044076637

VL - 7

SP - 335

EP - 358

JO - Liver Cancer

JF - Liver Cancer

SN - 2235-1795

IS - 4

ER -