Subclassification of Barcelona Clinic Liver Cancer B and C hepatocellular carcinoma: A cohort study of the multicenter registry database

Background and Aim:: We aimed to subclassify hepatocellular carcinoma (HCC) using Barcelona Clinic Liver Cancer intermediate and advanced stages, which include a highly heterogeneous population. Methods:: From two registries ("random" and "voluntary" cohorts in the Korean Liver Cancer Study Group), patients who were newly diagnosed as HCC with intermediate or advanced stage between 2003 and 2005 were considered eligible. Overall survival (OS) was analyzed using Kaplan-Meier method with comparison by log-rank test. Results:: Patients with intermediate-stage HCC (n=994) were subclassified according to tumor size and Child-Pugh class. Patients with tumor size<5cm (B1), those with tumor size≥5cm and Child-Pugh A (B2), and those with tumor size≥5cm and Child-Pugh B (B3) had median OS of 30.73, 20.60, and 9.23months, respectively (P<0.001 by log-rank test). Among patients with advanced stage HCC (n=1746), patients were subclassified according to presence of significant portal vein invasion (sPVI; defined as portal vein invasion in lobar, main, or contralateral branch) and extrahepatic spread (EHS). Patients with neither sPVI nor EHS (C1), those with either sPVI or EHS (C2), and those with both sPVI and EHS (C3) had median OS of 8.43, 4.63, and 3.63months, respectively (P<0.001 by log-rank test). Conclusion:: Subclassification of Barcelona Clinic Liver Cancer intermediate and advanced stages might be useful for determining patient prognosis and guiding treatment strategies for HCC.