| Title: |
Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice |
| Authors: |
Giannini E. G.; Bucci L.; Garuti F.; Brunacci M.; Lenzi B.; Valente M.; Caturelli E.; Cabibbo G.; Piscaglia F.; Virdone R.; Felder M.; Ciccarese F.; Foschi F. G.; Sacco R.; Svegliati Baroni G.; Farinati F.; Rapaccini G. L.; Olivani A.; Gasbarrini A.; Di Marco M.; Morisco F.; Zoli M.; Masotto A.; Borzio F.; Benvegnu L.; Marra F.; Colecchia A.; Nardone G.; Bernardi M.; Trevisani F; Olmi S; on behalf of Italian Liver Cancer (ITA. LI. CA) group |
| Contributors: |
Giannini, E. G.; Bucci, L.; Garuti, F.; Brunacci, M.; Lenzi, B.; Valente, M.; Caturelli, E.; Cabibbo, G.; Piscaglia, F.; Virdone, R.; Felder, M.; Ciccarese, F.; Foschi, F. G.; Sacco, R.; Svegliati Baroni, G.; Farinati, F.; Rapaccini, G. L.; Olivani, A.; Gasbarrini, A.; Di Marco, M.; Morisco, F.; Zoli, M.; Masotto, A.; Borzio, F.; Benvegnu, L.; Marra, F.; Colecchia, A.; Nardone, G.; Bernardi, M.; Trevisani, F; Olmi, S; on behalf of Italian Liver Cancer (ITA. LI., CA) group |
| Publisher Information: |
John Wiley and Sons Inc. |
| Publication Year: |
2018 |
| Subject Terms: |
Aged; 80 and over; Carcinoma; Hepatocellular; Databases; Factual; Female; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Precision Medicine; Prognosis; Retrospective Studies; Survival Analysis; Treatment Outcome; alpha-Fetoproteins |
| Description: |
The Barcelona Clinic Liver Cancer (BCLC) advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study, our aim was to assess treatment and overall survival (OS) of BCLC C patients subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified as: PS1 alone (n = 385; 46.1%), PS2 alone (n = 146; 17.5%), MVI (n = 224; 26.8%), EHS (n = 51; 6.1%), and MVI + EHS (n = 29; 3.5%). MVI, EHS, and MVI + EHS patients had larger and multifocal/massive HCCs and higher alpha-fetoprotein (AFP) levels than PS1 and PS2 patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months), and MVI + EHS (3.1 months; P < 0.001). Among MVI patients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHS patients (51.7%). Independent prognostic factors were: Model for End-stage Liver Disease score, Child-Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type. Conclusion: BCLC C stage does not identify patients homogeneous enough to be allocated to a single stage. PS1 alone is not sufficient to include a patient into this stage. The remaining patients should be subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796). |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/wos/WOS:000430388500016; volume:67; issue:5; firstpage:1784; lastpage:1796; numberofpages:13; journal:HEPATOLOGY; https://hdl.handle.net/20.500.11768/125294 |
| DOI: |
10.1002/hep.29668 |
| Availability: |
https://hdl.handle.net/20.500.11768/125294; https://doi.org/10.1002/hep.29668 |
| Accession Number: |
edsbas.A39F145D |
| Database: |
BASE |