Development of Hong Kong Liver Cancer Staging

System with Treatment Stratification for patient with

HCC
RFS Journal Primer Interventional Oncology SL

Quick Summary
BOTTOM LINE

The HKLC staging system had significantly better ability than the Barcelona Clinic Liver Cancer
system to better distinguish between patients with overall survival times. HKLC system identified
subsets of BCLC intermediate and advance-stage patients for more aggressive treatment than BCLC,
which improved survival times.

MAJOR POINTS

Development of a classification scheme with associated treatment guidance for Asian patients with
hepatocellular carcinoma

Survival benefit of radical therapies, compared to transarterial chemoembolization (TACE), was

substantial (52.1% vs. 18.7%)

Survival Benefit of radical therapies compare with systemic therapy was more pronounced (48.6%
vs. 0.0%)

CRITICISM

A single tertiary referral center in Hong Kong (lack of external validity)

A large majority of HCC patients (79.90%) were heptitis B infection carriers

The study was largely retrospective in nature, exposing it to potential bias

Study design
RETROSPECTIVE COHORT STUDY

3856 patients with HCC predominately related to Hep B

Time range: 1995-2008

Data was collected prospectively and entered in a master database comprising

2026 variables covering demographic, clinical, laboratory, treatment, and
survival data of each patient.

Patients were randomly allocated into two groups (a training set and a test set)
in an approximately 1:1 ratio

INCLUSION CRITERIA

All patients with an HCC diagnosis confirmed by either histology/cytology,

increased alpha-fetoprotein level ( 400 ng/mL), or by typical radiographic
appearance (mostly by CT) at Queen Mary Hospital in Hong Kong from January
1995 to December 2008

EXCLUSION CRITERIA

9 pediatric patients

63 patient who died or were censored within 7 days after the first consultation
and received no treatment.

Purpose

Study aimed to develop a new prognostic staging system with treatment guidelines based on
a large HCC cohort from a single tertiary referral center in Hong Kong compared data to the
BCLC staging classification.

Intervention

Patients were randomly allocated into two sets (a training set and a test set) in an
approximately 1:1 ratio
The prognostic staging system and treatment guidelines were constructed in the
training set.

The staging system and treatment guidelines were subsequently tested in the test set.

Barcelona Clinic Liver Cancer (BCLC) Staging Classification

Outcome

This study established a staging system in conjunction with a treatment algorithm applicable
to HCC patients in Asia that was able to significantly better distinguish between patients with
specific overall survival times as well as identifying subsets of BCLC intermediate and
advanced stage patients for more aggressive treatments.

Credits

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SUMMARY BY:

Andrew Niekamp, M.D., R-1 PGY-2

The Department of Diagnostic and Interventional Imaging
The University of Texas Health Science Center at Houston
*FYau T, Tang VY, Yao TJ, et al. Development of Hong Kong Liver Cancer Staging system with treatment stratification for patients with
hepatocellular carcinoma. Gastroenterology. 2014;146:1691700.

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