Cancer of the Liver Italian Program score helps identify potential candidates for transarterial chemoembolization in patients with Barcelona Clinic Liver Cancer stage C

摘要

BACKGROUND: The Barcelona Clinic Liver Cancer (BCLC) staging system for hepatocellular carcinoma (HCC) recommends transarterial chemoembolization (TACE) as the ifrst line therapy for stage B patients and sorafenib treatment for stage C patients. However, stage C patients exhibit variations in terms of tumor burden, liver function, and extrahepatic metastasis, which could potentially affect disease outcome. Here, we assessed whether the Cancer of the Liver Italian Program (CLIP) scores can help identify stage C patients likely to beneift from TACE. METHODS: Out of 295 BCLC stage C HCC patients enrolled between January 2009 and December 2011, those with platelet counts >30×109 cells/L, total bilirubin <51 µmoL/L, and an unob-structed main portal vein were scheduled for TACE (n=195). The remaining patients received best supportive care (BSC,n=100). All the patients were followed up for symptoms, performance status, and Child-Pugh classiifcation scores every 4 weeks un-til death or December 2013. The prognosis of each group was evaluated by using the log-rank test and Cox-Mantel test. RESULTS: The median overall survival (OS) was 6 months [95% conifdence interval (CI): 4.64-7.36]. The OS was 9 months for the TACE group and 4 months for the BSC group. The TACE group had a longer OS than the BSC subgroup for CLIP scores 0-2 [13 months (95% CI: 8.55-17.45) vs 4 months (95% CI:0.00-10.96),P=0.001]. No signiifcant differences were found be-tween the TACE and BSC groups for CLIP scores 3-5. The CLIP score and treatment methods were found to be independent prognostic factors. CONCLUSIONS: BCLC stage C HCC patients exhibit deifnite disease heterogeneity and can be reclassiifed by using the CLIP scoring system. Moreover, patients with CLIP scores 0-2 are likely to beneift from TACE. However, additional studies with long-term follow-up will be required to validate these ifndings.