Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 10 (4), e0124434
eCollection

Different Survival of Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma Patients by the Extent of Portal Vein Invasion and the Type of Extrahepatic Spread

Affiliations

Different Survival of Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma Patients by the Extent of Portal Vein Invasion and the Type of Extrahepatic Spread

Dong Hyun Sinn et al. PLoS One.

Abstract

Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival of patients based on the extent of portal vein invasion.
There was a significant survival difference based on the extent of portal vein invasion. The extent of PVI was classified as none (green), type-I (segmental or sectoral PVI, black), type-II (left and/or right main PVI, blue), and type-III (main trunk invasion or beyond, red). * P = 0.19; P = 0.01; P < 0.01.
Fig 2
Fig 2. Survival of patients based on the type of extrahepatic spread.
There was a significant survival difference based on the type of extrahepatic spread. Type of ES was classified as none (black), nodal metastasis only (N, blue) and distant metastasis with or without nodal metastasis (M and/or N, red). * P = 0.84; P < 0.01.
Fig 3
Fig 3. Survival of patients based on the sub-classification.
Patient survival was significantly different based on sub-classification of BCLC stage C patients. Sub-stage C1 includes the patients with portal vein invasion limited to the segmental or sectoral branch and extrahepatic spread limited to the nodal area (black). Sub-stage C2 includes the patients with portal vein invasion that extends beyond the right and/or left main branch without distant metastasis (green), and sub-stage C3 includes the patients with distant metastasis, but portal vein invasion limited to the segmental or sectoral branch (blue). Sub-stage C4 includes the patients with portal vein invasion that extends beyond the right and/or left main branch with distant metastasis (red). * P < 0.01.

Similar articles

See all similar articles

Cited by 18 PubMed Central articles

See all "Cited by" articles

References

    1. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379: 1245–1255. 10.1016/S0140-6736(11)61347-0 - DOI - PubMed
    1. Osaki Y, Nishikawa H. Treatment for hepatocellular carcinoma in Japan over the last three decades: Our experience and published work review. Hepatol Res. 2015;45: 59–74. 10.1111/hepr.12378 - DOI - PMC - PubMed
    1. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53: 1020–1022. 10.1002/hep.24199 - DOI - PMC - PubMed
    1. Park KW, Park JW, Choi JI, Kim TH, Kim SH, Park HS, et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area. J Gastroenterol Hepatol. 2008;23: 467–473. - PubMed
    1. Kee KM, Wang JH, Lin CY, Wang CC, Cheng YF, Lu SN. Validation of the 7th edition TNM staging system for hepatocellular carcinoma: an analysis of 8,828 patients in a single medical center. Dig Dis Sci. 2013;58: 2721–2728. 10.1007/s10620-013-2716-8 - DOI - PubMed

MeSH terms

Grant support

The authors have no support or funding to report.
Feedback