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Different survival of barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

Sinn DH, Cho JY, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC - PLoS ONE (2015)

Bottom Line: Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival.Also, different outcome was observed by treatment modalities in each sub-stage.Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

ABSTRACT
Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

No MeSH data available.


Related in: MedlinePlus

Survival of patients based on the type of extrahepatic spread.There was a significant survival difference based on the type of extrahepatic spread. Type of ES was classified as none (black), nodal metastasis only (N, blue) and distant metastasis with or without nodal metastasis (M and/or N, red). *P = 0.84; †P < 0.01.
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pone.0124434.g002: Survival of patients based on the type of extrahepatic spread.There was a significant survival difference based on the type of extrahepatic spread. Type of ES was classified as none (black), nodal metastasis only (N, blue) and distant metastasis with or without nodal metastasis (M and/or N, red). *P = 0.84; †P < 0.01.

Mentions: Survival differed according to the type of ES (Fig 2). The median survival of patients with PVI but without ES was 7.7 months, which was not different from the median survival of patients with nodal metastasis [7.0 months; unadjusted HR (95% CI): 1.02 (0.77–1.36), P = 0.84]. However, survival was significantly worse for patients with distant metastasis [median survival: 4.2 months; unadjusted HR (95% CI): 1.74 (1.42–2.13), P < 0.01].


Different survival of barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

Sinn DH, Cho JY, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC - PLoS ONE (2015)

Survival of patients based on the type of extrahepatic spread.There was a significant survival difference based on the type of extrahepatic spread. Type of ES was classified as none (black), nodal metastasis only (N, blue) and distant metastasis with or without nodal metastasis (M and/or N, red). *P = 0.84; †P < 0.01.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414501&req=5

pone.0124434.g002: Survival of patients based on the type of extrahepatic spread.There was a significant survival difference based on the type of extrahepatic spread. Type of ES was classified as none (black), nodal metastasis only (N, blue) and distant metastasis with or without nodal metastasis (M and/or N, red). *P = 0.84; †P < 0.01.
Mentions: Survival differed according to the type of ES (Fig 2). The median survival of patients with PVI but without ES was 7.7 months, which was not different from the median survival of patients with nodal metastasis [7.0 months; unadjusted HR (95% CI): 1.02 (0.77–1.36), P = 0.84]. However, survival was significantly worse for patients with distant metastasis [median survival: 4.2 months; unadjusted HR (95% CI): 1.74 (1.42–2.13), P < 0.01].

Bottom Line: Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival.Also, different outcome was observed by treatment modalities in each sub-stage.Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

ABSTRACT
Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

No MeSH data available.


Related in: MedlinePlus