Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5654-5662
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5654
Ascites and alpha-fetoprotein improve prognostic performance of Barcelona Clinic Liver Cancer staging
Asmaa I Gomaa, Alzhraa Al-Khatib, Wael Abdel-Razek, Mohammed Saad Hashim, Imam Waked
Asmaa I Gomaa, Wael Abdel-Razek, Mohammed Saad Hashim, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
Alzhraa Al-Khatib, Oncology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
Author contributions: Gomaa AI and Waked I conceived and designed the study; Gomaa AI, Hashim MS and Al-Khatib A collected the data; Gomaa AI, Abdel-Razek W, Hashim MS and Waked I analyzed and interpreted the data, and revised the manuscript; Gomaa AI and Waked I wrote the manuscript; Waked I revised and approved the final version of the manuscript.
Supported by Science and Technology Development Fund (STDF), Egypt, Project No. 1519.
Ethics approval: The study was reviewed and approved by the National Liver Institute Review Board (IRB00003413).
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: None related to this work, Waked I is a speaker for Hoffman La Roche, MSD, BMS, and Gilead; advisory boards for Janssen, Hoffman La Roche, and MSD; investigator in clinical trials for Hoffman La Roche, BMS, Bayer, Janssen, AbbVie, and Minapharm.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Asmaa I Gomaa, MD, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt. aibrahim@liver-eg.org
Telephone: +20-100-6157160 Fax: +20-48-2234586
Received: November 15, 2014
Peer-review started: November 17, 2014
First decision: December 11, 2014
Revised: December 31, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: May 14, 2015
Core Tip

Core tip: Although the Barcelona Clinic Liver Cancer (BCLC) system contains Child-Turcotte-Pugh classification as a main variable, a patient within BCLC stage A or B may have ascites, which can interfere with the recommended treatment. An elevated alpha-fetoprotein level, which is an integral part of other staging systems, may also impact prognosis and influence treatment decision. In this study, we evaluated the utility of adding ascites and the alpha-fetoprotein level to the BCLC system for predicting prognosis and survival in a large cohort of early and intermediate hepatocellular carcinoma patients at a tertiary referral center for liver disease in Egypt.