Prognostic performance of Hong Kong Liver Cancer with Barcelona Clinic Liver Cancer staging systems in hepatocellular carcinoma

Abstract

Background: Accurate staging is necessary for predicting hepatocellular carcinoma (HCC) prognosis and guiding patient management. The Barcelona Clinic Liver Cancer (BCLC) staging system has limitations due to heterogeneity observed among patients in BCLC stages B and C. In contrast, the Hong Kong Liver Cancer (HKLC) staging system offers more aggressive treatment strategies.

Aim: To compare the prognostic performance of HKLC and BCLC staging systems in Egyptian patients with HCC.

Methods: We conducted a retrospective study at the National Liver Institute, Menoufia University, Egypt, on 1015 HCC patients. Data was collected from patients' medical records over 10 years (from 2008 to 2018). The BCLC and HKLC stages were identified, and Kaplan-Meier survival analysis was used to compare patients' overall survival rates within each staging system. Additionally, we evaluated the comparative prognostic performance of the two staging systems.

Results: Hepatitis C was identified as the underlying etiology in 799 patients (78.7%), hepatitis B in 12 patients (1.2%), and non-viral causes in 204 patients (20.1%). The survival analysis demonstrated significant differences across the various stages within both the BCLC and HKLC systems. The receiver operating characteristic (ROC) curves indicated a marginally superior performance of the HKLC system in predicting survival at 1, 2, and 3 years compared to the BCLC system. Furthermore, the HKLC staging provided a slightly enhanced prognostic capability, particularly for patients classified under BCLC stages B and C, suggesting a potential survival benefit.

Conclusion: HKLC classification had a slightly better prognostic performance than BCLC staging system and may offer a survival advantage for certain patients with HCC in BCLC stage B and C HCC cases.

Keywords: Barcelona Clinic Liver Cancer; Egypt; Hepatocellular carcinoma; Hong Kong Liver Cancer; Prognostic performance; Staging systems.

Fig. 1

a Kaplan-Meier curve for overall survival for all patients. b Kaplan-Meier curve for overall survival analysis for all patients regarding treatment according to BCLC versus according to HKLC staging systems. c Kaplan-Meier survival curve for BCLC stages B and C patients regarding treatment within BCLC VS. Within HKLC. d Kaplan-Meier survival curve for all patients regarding BCLC Stage. e Kaplan-Meier survival curve regarding HKLC Stage

Fig. 2

Receiver operating characteristic (ROC) curves for HKLC and BCLC staging systems at one, two & three years