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HKLC Triages More Hepatocellular Carcinoma Patients to Curative Therapies Compared to BCLC and Is Associated with Better Survival

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Abstract

Background and Aims

The Hong Kong Liver Cancer (HKLC) system proposes to triage hepatocellular carcinoma (HCC) patients to more aggressive treatment and may be associated with superior survival compared with the Barcelona Clinic Liver Cancer (BCLC) system. We aimed to identify the influence of adherence to HKLC or BCLC treatment recommendations on survival and time to progression.

Methods

We examined a prospectively enrolled cohort of 292 patients undergoing 532 treatment episodes from a single clinical center.

Results

The BCLC and HKLC systems accurately predicted overall survival and time to progression after each treatment episode (BCLC: p < 0.001; HKLC: p < 0.001). Adherence to treatment recommendations was higher for HKLC than for BCLC (55.6 vs. 47.9%, p = 0.01). Survival was superior with adherence to HKLC recommendations compared to non-adherence (45.3 vs. 27.1 months, p < 0.001). There was no difference in survival in BCLC with adherence compared to non-adherence (34.6 vs. 32.3 months, p = 0.96). The survival benefit was limited to early- and very early stage disease for both HKLC (p < 0.001) and BCLC (p = 0.007). More patients were triaged to curative therapies by HKLC than BCLC (p = 0.004). The use of transarterial chemoembolization instead of ablation or resection in early- and very early stage disease for technical reasons was the major cause for non-recommended treatment and was associated with worse survival (p < 0.001).

Conclusions

These data support the use of HKLC in early- and very early stage HCC. Efforts should be made to overcome technical reasons for not performing ablation in early- and very early stage disease.

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Abbreviations

HKLC:

Hong Kong Liver Cancer

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

AASLD:

American Association for the Study of Liver Disease

EASL:

European Association for the Study of the Liver

SCGH:

Sir Charles Gairdner Hospital

OLTx:

Orthotopic liver transplantation

TACE:

Transarterial chemoembolization

SIRT:

Selective internal radiotherapy

NAFLD/NASH:

Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

HR:

Hazard ratio

95% CI:

95% confidence interval

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Authors and Affiliations

  1. Department of Hepatology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA, 6009, Australia

    Michael C. Wallace, George Garas, Leon A. Adams, Gerry MacQuillan & Gary P. Jeffrey

  2. School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia

    Michael C. Wallace, Yi Huang, Leon A. Adams, Gerry MacQuillan & Gary P. Jeffrey

  3. School of Population Health, University of Western Australia, Nedlands, WA, Australia

    Michael C. Wallace & David B. Preen

  4. Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Jonathan Tibballs, John Ferguson & Shaun Samuelson

Authors
  1. Michael C. Wallace
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  2. Yi Huang
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  3. David B. Preen
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  4. George Garas
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  5. Leon A. Adams
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Correspondence to Michael C. Wallace.

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Wallace, M.C., Huang, Y., Preen, D.B. et al. HKLC Triages More Hepatocellular Carcinoma Patients to Curative Therapies Compared to BCLC and Is Associated with Better Survival. Dig Dis Sci 62, 2182–2192 (2017). https://doi.org/10.1007/s10620-017-4622-y

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  • DOI: https://doi.org/10.1007/s10620-017-4622-y

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