Are The Surgical Indications Of Barcelona Clinic Liver Cancer Staging Classification Justified? Results And Revision Proposals

Background: Liver resection is one of the most effective treatments for hepatocellular carcinoma (HCC). The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for very early stage and a small part of early stage HCC patients. The surgical indications of the BCLC staging system needs to be re-evaluated. Method: 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, the survivals of the patients at early, intermediate and advanced stage were analyzed. The severity of liver cirrhosis was recruited into a revised BCLC staging system. The patients were again stratified to the revised BCLC staging system; the survivals of the patients at different stages after liver resection were analyzed. Result: The 1-, 2-, 3-year overall survivals of this cohort were 81.6%, 68.3%, 57.5%. When the patients were stratified to the BCLC staging system, no significant difference in the survivals was found between the patients at early and intermediate stage (p=0.15). After severity of liver cirrhosis was recruited into the revised BCLC staging system, the patients were again stratified to the revised BCLC staging system, and there was a significant difference in the survivals between the patients at early and intermediate stage (p=0.009). Conclusions: The surgical indications of the BCLC staging system are not justified for HCC treatment. The revised BCLC staging system with recruitment of liver cirrhosis is more effective in determining treatment modality and predicting outcomes.