Application value of different Barcelona clinical liver cancer Kinki staging in radical resection of liver cancer

Objective:To investigate the application value of different Barcelona clinical liver cancer (BCLC) Kinki staging in radical resection of liver cancer.
Methods:The retrospective case-control study was conducted. The clinicopathological data of 112 patients with BCLC stage B liver cancer who underwent radical resection in the First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were collected. There were 92 males and 20 females, aged from 21 to 86 years, with a median age of 59 years. All patients underwent radical resection of liver cancer. Observation indicators: (1) clinicopathological data of patients; (2) follow-up and survival; (3) analysis of influencing factors for prognosis of patients. Follow-up was performed through outpatient examination and telephone interview including alpha fetalprotein (AFP), liver function, ultrasonography, enhanced computed tomography or magnetic resonance imaging. The follow-up was performed once every three months within postoperative one year and once every six months thereafter to detect survival of patients up to September 2020. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. The life-table method was used to calculate survival rates, Kaplan-Meier method was used to draw survival curves, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard model.
Results:(1) Clinicopathological data of patients: of the 112 patients, 38 were in BCLC Kinki stage B1 and 74 were in BCLC Kinki stage B2. Cases with preoperative AFP≤20 μg/L or >20 μg/L, cases with or without microvascular invasion (MVI), cases with or without tumor recurrence in BCLC Kinki stage B1 and BCLC Kinki stage B2 patients were 20,18, 25, 13, 25, 13 and 22, 49, 30, 41, 22, 52, respectively, showing significant differences in the above indicators (x²=4.897, 5.485, 13.405, P<0.05). (2) Follow-up and survival: 112 patients were followed up for 2-44 months. The 1-, 2-, 3-year overall survival rates of patients in BCLC Kinki stage B1 and BCLC Kinki stage B2 were 92%, 86%, 74%, 78%, 61%, 45% and tumor-free survival rates were 84%, 53%, 43%, 35%, 23%, 20%, respectively. There were significant differences in the overall survival and tumor-free survival between BCLC Kinki stage B1 and B2 patients (x²=7.571, 15.115, P<0.05). (3) Analysis of influencing factors for prognosis of patients: results of univariate analysis showed that BCLC Kinki staging, age, MVI and tumor differentiation were related factors for overall survival of patients after radical resection of liver cancer ［hazzard ratio (HR)=2.985, 1.930, 3.520, 3.406, 95% confidence interval (CI) as 1.318-6.763, 1.023-3.642, 1.714-7.230, 1.571-7.385, P<0.05］; BCLC Kinki staging, preoperative AFP, MVI and tumor differentiation were related factors for tumor-free survival of patients after radical resection of liver cancer (HR=2.806, 2.122, 2.826, 2.914, 95%CI as 1.632-4.823, 1.266-3.556, 1.743-4.580, 1.601-5.306, P<0.05). Results of multivariate analysis showed that BCLC Kinki staging, age, MVI and tumor differentiation were independent influencing factors for overall survival of patients after radical resection of liver cancer (HR=2.587, 2.568, 2.280, 4.328, 95%CI as 1.036-6.462, 1.215-5.429, 1.011-5.141, 1.677-11.171, P<0.05); BCLC Kinki staging, preoperative AFP, MVI and tumor differentiation were independent influencing factors for tumor-free survival of patients after radical resection of liver cancer (HR=2.579, 1.942, 2.572, 2.750, 95%CI as 1.426-4.662, 1.109-3.400, 1.505-4.397, 1.436-5.269, P<0.05). Further analysis of influence of BCLC Kinki staging and MVI on prognosis of patients showed that the 1-, 2-, 3-year overall survival rates of patients in BCLC Kinki stage B1 without or with MVI were 96%, 91%, 91%, 85%, 75%, 45% and tumor-free survival rates were 96%, 63%, 48%, 62%, 21%, 21%, respectively, showing significant differences in the above indicators (x²=4.431, 7.447, P<0.05).
Conclusions: BCLC Kinki staging can judge the prognosis of patients after radical resection of liver cancer. BCLC Kinki stage B1 liver cancer patients have better prognosis.