Accordingly, the bclc staging system is viewed as being necessary for clinical trials and the reporting of. For advancedstage hcc, the bclc treatment strategy includes for the first line nexavar sorafenib, lenvatinib. Several classifications are currently available for tumor staging in order to determine patient prognosis. However, this system has not been prospectively validated in a large cohort of hcc patients. Barcelona clinic liver cancer bclc staging and treatment strategy for hepatocellular carcinoma hcc1 potential candidate for liver transplantation solitary portal pressure. Diagnosis, staging, and treatment of hepatocellular carcinoma josep m. Prognosis assessment in surgical patients with hepatocellular carcinoma hcc remains controversial. Among the prognostic variables considered in bclc staging are performance status ps and portal. However, there is a need to update the bclc staging system to include recent data on locoregional and systemic therapies for hcc, expanded criteria for transplantation, and systemic therapy for hepatitis c infection. Barcelona clinic liver cancer bclc staging uses a set of criteria to guide management of patients with hepatocellular carcinoma hcc.
This study includes the widest comparison among staging systems, in comparison with other retrospective studies in which the limited collection of data impairs the ability to test all the systems available. European and american guidelines have endorsed the barcelona clinic liver cancer bclc staging system. The bclc staging system may discriminate patients at early stages, and guide the treatment strategy. Find out what the bclc staging system and the childpugh system are, and about treatment options for primary liver cancer. The jis score has been proposed and used in japan, although it. The childpugh score is actually part of the bclc and clip staging systems mentioned previously. The bclc staging system was assessed on western and asian cohorts12, and demonstrated a better ability to predict survival than most other scores9,14.
Bclc online casino, sports betting, lottery, and legal. Knowing the stage helps your doctor work out the best treatment. The bclc staging system is recommended for prognostic selection and treatment assignment. Development of hong kong liver cancer staging system with treatment strati. Different staging and grading systems are used for different cancers. The bclc system divides patients into 5 distinct cohorts based on liver function child pugh, patient comorbidities performance status, and tumor burden. It was designed to be a staging classification to guide treatment decisions and to assign patients to the best treatment option in. We have attempted to independently validate these newer staging systems. Sports betting, lottery tickets, online casino gaming, and more. In north america, staging systems currently in use include the radiologic t staging system advocated both by unosoptn and lirads, the bclc staging system advocated by the aasld, and the tnm system developed and maintained by the american joint committee on cancer ajcc.
However, hcc staging systems remain a controversial issue. Schematic for hepatocellular carcinoma hcc from the barcelona clinic liver cancer bclc staging system. The bclc staging system was proposed and has been validated by several groups in the united states and europe to offer the best means of stage classification and treatment guidance for hcc. The barcelona clinic liver cancer staging classification bclc is probably the most widely used system to stage patients with hepatocellular carcinoma hcc. For the second line stivarga regorafenib, cabozantinib, ramucirumab. Lenvatinib as an initial treatment in patients with. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to.
The barcelona clinic liver cancer bclc staging system is the most widely used and complete evaluation system for therapeutic allocation, as well as prognostic stratification 6, 7. The bclc staging system may discriminate patients at early stages, and guide the. State of the art jeanluc raoul institut paolicalmettes, marseille france esmo summit africa, cape town, 1012 february 2017. Introduction the bclc staging classification was developed in 1999 based on cohorts of patients in europe, predominantly hcvinfected. Evidencebased diagnosis, staging, and treatment of patients.
The aim of this study was to assess the performance of the recently developed hong kong liver cancer hklc classification as a staging system for hepatocellular carcinoma hcc in europe. Llovet,1 josep fuster,2 and jordi bruix1 of the barcelonaclnic liver cancer group. Grading vs staging cancer diagnosis tumor grade and. Staging systems in hepatocellular carcinoma sciencedirect.
Barcelona clinic liver cancer nomogram and others stagingscoring. Barcelona clinic liver cancer bclc staging and treatment strategy for hepatocellular carcinoma hcc1 indication u n resect a b l e p a tient s algoritm combining t umor car acteristics and liver function1 stage 0 pst 0, childpugh a very early stage 0 single hcc bclc staging and treatment strategy for hepatocellular carcinoma hcc1 potential candidate for liver transplantation solitary portal pressure. At least 10 staging systems have been developed to provide treatment and prognostic information for patients with hcc. Limitations of the barcelona clinic liver cancer staging. Development of hong kong liver cancer staging system with. Performance status, ast, abdominal pain, and esophageal varices improved the discriminatory ability of clip. Some types of cancer do not have a specific staging or grading system. In addition to conventional treatments, our site is always involved in international clinical trials promoted by pharmaceutical industry. Subclassification of bclc b stage hepatocellular carcinoma. As it is not based on identification of prognostic factors from a regression analysis, bclc is not able to predict the mortality in hcc patients. Many staging systems exist, none of which is proven superior. Bclc staging system and the childpugh system liver cancer.
Clip, cupi, and getch were the three topranking staging systems. Liver cancer bclc staging radiology reference article. The barcelona clinic liver cancer bclc staging system for hepatocellular carcinoma. Poon1 1department of surgery and state key laboratory of liver research, 2clinical trials centre, the university of hong kong. The bclc staging classification links the stage of the disease to a specific treatment strategy.
Other staging systems such as the hong kong liver cancer staging system have recently been proposed to replace bclc. Llovet,1 josep fuster,2 and jordi bruix1 of the barcelonacl. Evidencebased diagnosis, staging, and treatment of. This classification has imposed itself from its practical aspect and for being the only one linked to a treatment. The chart showing pdf series, word series, html series, scan qr codes. Bclc staging system and the childpugh system liver. Tang,1,2, tzyjyun yao,2, sheungtat fan,1 chungmau lo,1 andronniet. Every lottery ticket thats purchased helps communities across b. Talk to your doctor if you have questions about staging. Diagnosis, staging and treatment of hepatocellular carcinoma. Pdf validation of the bclc prognostic system in surgical. Barcelona clinic liver cancer bclc staging for hepatocellular carcinoma. Comparison of clip, tnm and bclc staging systems for. Iicc intermediate multinoduear, stage d okuda 3, pst childpugh c stages a c okuda 12, pst 02, childpugh ab early stage a singie or 3 nodules bclc staging system, it remains the most validated and reliable system for prognostication.
Hong kong liver cancer staging system is associated with. The most widely used hcc prognostic tool is the barcelona clinic liver cancer bclc classification, but its prognostic ability in surgical patients. The classification system sorts patients into one of four categories. Diagnosis, staging, and management of hepatocellular. Assessment of the hong kong liver cancer staging system in. Bclc now also an internationally acclaimed prognostic. The bclc system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.
Bclc and tnm sixth edition lacked any meaningful prognostic discrimination. The hong kong liver cancer staging system stratifies patients into nine strata according to outcome and treatment to be applied as derived from statistical modelling and personal insight. Prospective validation of the barcelona clinic liver. Okuda system in most cases, doubts have been raised regarding its value in certain populations. Applicability of the bclc staging system to patients with. The bclc staging system is applied in the guidelines published by the american association for the study of liver diseases aasld 1 and the guidelines published collaboratively by the. The barcelona clinic liver cancer bclc group defines intermediatestage hepatocellular carcinoma hcc as bclc stage b. They also need to know how well your liver is working, especially if you also have scarring of the liver cirrhosis.
The barcelona clinic liver cancer bclc staging system is the most widely used treatment algorithm worldwide 5. Doctors need to know the size and position of the liver cancer to make decisions about your treatment. Bclc barcelona clinic liver cancer clinic barcelona hospital universitari villarroel, 170 08036 barcelona t. Various other staging systems used in hcc include the european systems french staging system, barcelona clinic liver cancer bclc staging system and the cancer of the liver italian program clip and asian systems okuda staging system, japan integrated staging jis, tokyo score and chinese university prognostic index cupi. The categories are based on how well you can carry out daily tasks, what the tumour is like, and how well the liver is working. Optimal staging system for hepatocellular carcinoma. Rads, the bclc staging system advocated by the aasld, and the tnm system. The classification takes the following variables into account 1,2. It has been endorsed both by the easl and the aasld. Unique to the bclc, recommendations for therapy are provided according to stage. The barcelona clinic liver cancer bclc system is often used to stage hcc. The results obtained for the hklc staging system then were compared with those for the bclc staging system. The hong kong liver cancer staging system stratifies patients into nine strata according to outcome and treatment to be applied as derived. Formal staging systems such as those described before can often help doctors determine a patients prognosis outlook.
What is the barcelona clinic liver cancer bclc staging. The most common staging system for liver cancer is the barcelona clinic liver cancer bclc system. Barcelona clinic liver cancer bclc staging uses a set of criteria to guide the management. The latest update was in 2010 to date, the bclc staging classification for hcc is the most popular treatment algorithm in western countries.
The estimates of standard errors of the difference between the 2 systems were obtained by bootstrapping with bootstrap samples repeated in each imputed test set. Physicians use the stage and grade of the cancer, as well as other factors, to help plan treatment, estimate how the cancer might respond to treatment and give a prognosis the expected outcome or course. Staging and prognostic models for hepatocellular carcinoma. Cancer staging contributes to prognostication, guides management decisions, and informs clinical, epidemiologic, and health services research. Barcelona clinic liver cancer bclc staging and treatment strategy for hepatocellular carcinoma hcc1 indication u n resect a b l e p a tient s algoritm combining t umor car acteristics and liver function1 stage 0 pst 0, childpugh a very early stage 0 single hcc staging systems, in comparison with other retrospective studies in which the limited collection of data impairs the ability to test all the systems available. There are 5 stages stage 0 followed by stages a, b, c and d. Bclc staging and treatment strategy as developed in our unit. Image reproduced with permission reproduced with permission of the. The bclc staging system is developed from the results obtained in the setting of several cohort studies and rcts 1,3,28. Liver prognostic factors for survival in patients with.