Kinki criteria for the subclassification of intermediate-stage hepatocellular carcinoma: Clinical implication

Abstract

Purpose: to subclassify the intermediate stage hepatocellular carcinoma (HCC) by using Kinki criteria.
Methods: A cross-sectional study was conducted on 109 patients with intermediate stage HCC from 01/2022 to 08/2023 at Hue University of Medicine and Pharmacy Hospital and Hue Center Hospital. HCC was diagnosed using the practice guideline of the Ministry of Health 2020, classified into the intermediate stage according to BCLC 2012. Intermediate stage HCC was then subclassified by using Kinki criteria. Treatment indications were documented. Clinical implication of Kinki criteria was reviewed and discussed.
Results: Mean age: 64.2 ± 13 years, male: female ratio 7:1. Average tumor size: 8.9 ± 3.6 cm. Subclassification of 109 intermediate stage HCC (BCLC-B) included 21 (19.3%) B1, 76 (69.7%) B2, and 12 (11%) B3. The subgroup B3 was further classified as B3a (n=2, 1.8%) and B3b (n=10, 9.2%). Treatment indications followed BCLC-B 2012 recommendation in 47.7% of cases (TACE: transarterial chemoembolization) whereas 52.3% were outside, including resection (22%), systemic chemotherapy (18.3%), conservative (9.2%) and radiofrequency ablation (2.8%). Comparing clinical treatment indications and recommendations of Kinki criteria we found: 100% of patients were in group B1; 76.4% of patients in group B2 and 66.7% of patients in group B3 received treatment corresponding to the
recommendation of Kinki criteria.
Conclusion: Intermediate-stage HCC encompasses a wide and heterogeneous population in terms of performance status, tumor burden and underlying liver function. Subclassification of patients in this stage using Kinki criteria helps optimize treatment strategies and improve patient prognosis.