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Subclassifying patients with HCC may predict disease burden, survival

Research on patients enrolled in the Barcelona Clinic Liver Cancer intermediate stage patient subclassification cohort showed that further classification of patients with untreated hepatocellular carcinoma may enable prediction of various stages of survival and disease burden, according to published findings.

“The evaluation of the outcome of untreated [Barcelona Clinic Liver Cancer intermediate stage]  patients allows us to test the prognostic capability of the proposed subclassification without incurring in the potential bias of treatment allocation, thus providing a solid point of reference for comparison of survival once a determined treatment is applied to a definite subpopulation,” Edoardo G. Giannini, MD, PhD, FACG, department of internal medicine, University of Genova, Italy, and colleagues wrote.

To facilitate treatment decisions, a panel of experts previously proposed subclassification of Barcelona Clinic Liver Cancer intermediate stage (BCLC B) patients in an effort to determine the best treatment decisions. In this study, researchers analyzed the prognosis of 269 patients with HCC who were untreated between 1987 and 2012. These patients were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. The various substages were measured for survival and outcomes.

“We aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group,” the researchers wrote.

Overall, “median survival decreased from stage B1 (n = 65, 24.2%: 25 months) through stages B2 (n = 105, 39%, 16 months) and B3 (n = 22, 8.2%, 9 months) to stage B4 (n = 77, 28.6%, 5 months; P < .0001),” they wrote. The researchers also observed different survival rates between stages B1 and B2 (P = .0002); B2 and B3 (P < .0001); and B3 and B4 (P = .0219).

Independent predictors of survival determined by multivariate analysis included BCLC B subclassification (P < .0001), MELD score (P = .0013) and platelet count (P = .0252).

A MELD score less than 11 (P < .0001), absence of esophageal varices (P = .0003) and diagnosis of HCC after the year 2000 (P = .0009) were associated with better survival.

The researchers concluded: “The survival figures that we identified in these untreated patients may be used to compare the potential survival advantage provided by various treatments. Further studies are warranted to assess whether inclusion of the MELD score may provide a finer prognostic tuning and more appropriate treatment allocation.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.