Background

The Barcelona Clinic Liver Cancer (BCLC) system has been endorsed by international guidelines as a staging algorithm of hepatocellular carcinoma. This analysis was performed to assess the outcome of liver transplantation in patients treated against the BCLC recommendations.

Methods

The data of 198 patients who underwent liver transplantation for hepatocellular carcinoma were extracted from a prospectively maintained database to classify the patients according to the BCLC system.

Results

BCLC staging was as follows: 0, n = 5; A, n = 77; B, n = 41; C, n = 53; and D, n = 22. Accordingly, liver transplantation was performed in the majority of patients against BCLC recommendations. Surgery (n = 16), radiofrequency ablation (n = 15) and transarterial chemoembolization (n = 151) preceded liver transplantation in 182 patients. Sixteen patients were transplanted without pretreatment. The1-, 5- and 10-year survival rates were 83.8%, 62.4% and 45.9%, and 1-, 5-, and 10-year recurrence rates were 7.7%, 22.7% and 26.7%. The BCLC classification did neither impact survival (P = 0.796) nor recurrence (P = 0.693). In the Cox analysis, RECIST tumor progression and initial alpha fetoprotein were independent predictors of outcome.

Conclusions

Neither the oncological nor the functional stratification imposed by the BCLC system was of importance for outcome. Lack of flexibility and disregard of biological parameters hamper its clinical applicability in liver transplantation.

中文翻译：

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肝移植和 BCLC 分类：限制阻碍最佳治疗

背景

巴塞罗那临床肝癌 (BCLC) 系统已被国际指南认可为肝细胞癌的分期算法。进行该分析是为了评估根据 BCLC 建议进行治疗的患者的肝移植结果。

方法

从前瞻性维护的数据库中提取 198 例因肝细胞癌接受肝移植的患者的数据，根据 BCLC 系统对患者进行分类。

结果

BCLC 分期如下：0，n  = 5；A，n  = 77；B，n  = 41；C，n  = 53；和 D，n  = 22。因此，大多数患者都违反了 BCLC 的建议进行了肝移植。 182 名患者在肝移植之前进行了手术 ( n  = 16)、射频消融 ( n  = 15) 和经动脉化疗栓塞 ( n = 151)。16 名患者在未经预处理的情况下进行了移植。1、5、10年生存率分别为83.8%、62.4%和45.9%，1、5、10年复发率分别为7.7%、22.7%和26.7%。BCLC 分类既不影响生存（P  = 0.796）也不影响复发（P  = 0.693）。在 Cox 分析中，RECIST 肿瘤进展和初始甲胎蛋白是结果的独立预测因子。

结论

BCLC 系统强加的肿瘤分层和功能分层对结果都不重要。缺乏灵活性和对生物学参数的忽视阻碍了其在肝移植中的临床适用性。