Survival analysis of proposed BCLC B subgroups in hepatocellular carcinoma patients

A Weinmann; S Koch; H Schulze-Bergkamen; M Sprinzl; C Düber; H Lang; G Otto; MA Woerns; PR Galle

doi:10.1055/s-0033-1360999

Zeitschrift für Gastroenterologie, Table of Contents

Survival analysis of proposed BCLC B subgroups in hepatocellular carcinoma patients

A Weinmann ², S Koch ², H Schulze-Bergkamen ³, M Sprinzl ², C Düber ⁴, H Lang ⁵, G Otto ⁶, MA Woerns ², PR Galle ²

¹University Medical Center of the Johannes Gutenberg University Mainz, Clinical Registry Unit (CRU), Mainz, Germany
²University Medical Center of the Johannes Gutenberg University Mainz, Department of Internal Medicine I, Mainz, Germany
³University Clinic of Heidelberg, 3National Center for Tumor Diseases (NCT), Department of Medical Oncology, Heidelberg, Germany
⁴University Medical Center of the Johannes Gutenberg University Mainz, Department of Diagnostic and Interventional Radiology, Mainz, Germany
⁵University Medical Center of the Johannes Gutenberg University Mainz, Department of Department of General, Visceral and Transplant Surgery, Mainz, Germany
⁶University Medical Center of the Johannes Gutenberg University Mainz, Department of Transplantation and Hepatobiliopancreatic Surgery, Mainz, Germany

Abstract

Goals: Analysis of the prognostic significance of a proposed subclassification of the BCLC B score in a well-characterized German population.

Background: The BCLC staging system is widely used to facilitate treatment decisions in patients with HCC. Due to observed clinical heterogeneity of the intermediate stage BCLC B, a subclassification was recently proposed taking the Child-Pugh score and extended criteria for transplantation (Up-To-Seven criteria) into account.

Study: In this retrospective study a consecutive cohort of 884 HCC patients was analysed, 254 patients with HCC stage BCLC B were identified and grouped according to the proposed subclassification. Baseline patient- and tumor characteristics, therapy and overall survival were analysed.

Results: Subgroup analysis identified BCLB B1/B2/B3 and B4 patients in 16.1/56.7%/7.9% and 19.3%. Overall survival (OS) correlated with subgroups and was 28.5/22.8/12.3 and 5.9 months in patients without liver transplantation (OLT). OS compared between adjacent subgroups (B1 vs. B2, B2 vs. B3, B3 vs. B4) did not reach statistical significance, but groupwise comparison showed significant differences between B1 vs. B3, B1 vs. B4 and B2 vs. B4. Overall survival was significantly improved in patients undergoing OLT (p < 0.0001).

Conclusions: The proposed BCLC B subclassification is prognostically meaningful and has the potential to be a useful new tool to better stratify treatment decisions. Although we could not confirm OS differences in adjacent subclassifications, significance was reached for the comparison of B1 vs. B3, B1 vs. B4 and B2 vs. B4. 5-year survival of patients transplanted in stage BCLC B with OTL was comparable to previously published results.

Further data analysis in larger collectives with homogenous staging and treatment strategies is needed to confirm the prognostic significance of the proposed subclassifications.