Role Of Modified Barcelona Clinic Liver Cancer (mBCLC) Staging System For Evaluating Prognoses Of Hepatocellular Carcinoma Patients After Curative Resection

Objective:The albumin-bilirubin(ALBI)grade is accurate,objective evidence-based alternative to the Child-Pugh Score(CP)for hepatocellular carcinoma(HCC),and the ALBI-based BCLC(Barcelona Clinic Liver Cancer)staging system in evaluating prognoses of HCC patients is also more accurate than the CP-based BCLC staging system.In our previous study,we found that the prealbumin-Bilirubin Grade(modificated ALBI grade or m ALBI grade)in evaluating liver reserve of HCC patients is better than ALBI grade.We aimed to investigate whether the m ALBI-based BCLC(modified BCLC,m BCLC)staging system could better evaluate the prognoses than the ALBI-based BCLC staging system.Methods:From October 2009 to May 2011,seven hundred patients undergoing curative resection(R0 or R1)for HCC from our hospital were evaluated.Predictors of survival were identified using univarite and multivariate Cox model analyses.Survival curves were calculated using the Kaplan-Meier method and compared the differences by a log-rank test.The homogeneity,heterogeneity,model fit and prediction accuracy of these groups were reflected by-2log likelihood,linear trend χ2 test,Akaike information criterion(AIC)and Harrell’s concordance index(C-index).Results:A total of 700 patients with curative resectable HCC were included in the study.They include 604 male and 96 female,with a median age of 52.2±11.4 years(range 13-83 years).In CP-based BCLC staging system,76.9% BCLC(CP)A patients,17.5% BCLC(CP)B patients and 5.6% BCLC(CP)C patients.The 1-,3-,5-year survival rates,on the basis of BCLC(CP)staging system,were stage A,92.8%,78.4%,68.6%;stage B,81.3%,54.5%,42.3%;stage C,46.2%,2.6%,0%.Among the BCLC(ALBI)staging system,76.6%,17.0%,6.1% and 0.3% patients were classified as BCLC(ALBI)stage A,B,C and D,respectively.One year survival rates for BCLC(ALBI)stage A,B,C and D were 92.9%、81.5%、48.8%、50%,three year survival rates for BCLC(ALBI)stage A,B,C and D were 78.9%、54.6%、2.3%、50%, five year survival rates for BCLC(ALBI)stage A,B,C and D were 69%、42%、0%、50%.In m ALBI-based BCLC staging system,75.6%,16.1%,5.6% and 2.7% were BCLC(m ALBI)A,B,C,D stage patients,the 1-,3-,5-year survival rates,were stage A,93.4%,79.8%,69.9%;stage B,84.1%,57.5%,44.2%;stage C,53.8%,2.6%,0%;stage D,36.8%,10.5%,5.3%.By comparing the homogeneity and heterogeneity,the ALBI grade can better perform the prediction accuracy of the overall survival than the CP grade.Similarly,in the BCLC(CP)、 BCLC(ALBI)、 BCLC(m ALBI)staging systems,the predicting accuracy of the overall survival,BCLC(m ALBI)perfoms the best,BCLC(ALBI)followed.In predicting the prognoses of CP A patients,BCLC(m ALBI)still performs the best,is superior to BCLC(ALBI).In predicting the prognoses of ALBI 1、ALBI 2 patients,CP grade cannot distinguish the difference of overall survival,and the BCLC(m ALBI)performs the best predictive power(p<0.001).Conclusions:In evaluating liver reserve of HCC patients,m ALBI grade is better than ALBI grade and CP score.Similarly,to compare the BCLC(CP),BCLC(ALBI)and BCLC(m ALBI)staging systems in evaluating the prognoses of the patients undergoing curative resection for HCC,we found that the BCLC(m ALBI)performs the best.The conclusion still need multicenter,large sample research for validating.