The Value Of BCLC And HKLC Liver Cancer Staging System In Clinical Application

Objective: Hepatocellular Carcinoma is one of common malignant tumor in our country that hard to find and the prognosis is poor.therefore,find ing suitable liver cancer staging system that accord China’s national conditions to assess the prognosis and guiding therapy is very important.By studying the analysis independent prognostic factor in patients with hepatocellular carcinoma(HCC),comparing BCLC’s with HKLC’s ability to assess prognosis and guide the therapy,we can find out the suitable one and guide the application of clinical treatment strategies.Methods: 1,Data from 709 patients who diagnosed hepatocellular carcinoma and admitted to tumour hospital of GuangXi medical university from August 2009 to March 2011 were reviewed retrospectively,and follow-up deadline: June 31,2016.Analyse the clinical data when patients initial visit and all data were performed by single factor analysis to determine the prognostic factors by using Kaplan-Meier method and Log-rank test,and thenindependent prognostic factors were identified by Cox proportional hazard regression models.Clinical stagings were done according to BCLC and HKLC,and the survival curves were drawn by Kaplan-Meier method.The Log-rank test is used for data comparison and built the Proportional Hazard Model of Cox’s Regression,Calculated the model contribution value of BCLC and HKLC.Using the likelihood ratio chi-square test,linear trend chi-square test,ROC curve to compare the homogeneity,discrimination and monotonicity of 2staging systems.Patients were grouped according to different therapy,and drawn the survival curve by Kaplan-Meier method,compared the ability of each installment treatment guidelines by Log-rank test.2,Analysis the patients with liver cancer patient data(449 cases)who accepted surgical treatment for the first time in 709 patients,respectively,according to BLCL and HKLC staging,and drawn survival curve by Kaplan Meier-method,use the Log-rank test differences in survival curve,to assess the guiding value of the treatment,so as to clear the application scope of liver resection.Results: 1,as of December 31,2016,a total of 509 patients died,202 patients were alive,lost to follow-up rate was 9.4%(n = 67).Median survival was 17.8 months,and the 1,3,5 year survival rate are 59 ± 1.9% respectively,34±1.7%,26±1.6%.Cox regression analysis showed that tumor size,the presence or absence of vascular or biliary bolt,lymph node metastasis and extrahepatic metastases,AFP,TB,ALB,Child-Pugh classification,therapy were independent prognostic factors for HCC patients.Kaplan-Meier survivalcurve and Log-rank test showed that each staging system was associated with the prognosis of the patients.The prognosis was worse in later cases(P =<0.0001).The likelihood ratio chi-square test and linear trend chi-square value showed HKLC was the best system in homogeneity,discriminative and trend of the best single.The ROC curves indicated that the HKLC(AUC=0.840)were better in discriminative and trend of the best single od survival rates and the follow-up deadline,and the 1,3,5 of the ROC curves indicated that HKLC(AUC=0.812)>BCLC(AUC=0.786)、HKLC(AUC=0.830)>BCLC(AUC=0.820)、 BCLC(AUC=0.739)>HKLC(AUC=0.729).2,For patients with confirmed for the first time,whether to accept surgery or TACE,HKLC has better guidance,more early than HKLC type IIb,BCLC B stage patients,cumulative survival rate of surgical treatment is better than the TACE,and it shows the value for the choice of treatment.Conclusion: HKLC has better prognosis assessment ability than BCLC;HKLC and BCLC can guide the choice of treatment scheme,and HKLC is the better one.BCLC treatment advice is not completely suitable for patients of hepatocellular carcinoma in China,the application scope is too harsh,liver resection for some BCLC stage B and even a few C patient also can be considered;HKLC installment system as a "young boy" has ability of evaluating prognosis and guiding treatment effect,to a certain extent,it is better than the BCLC stage,but it still need to verify by more large sample of clinical test.