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Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice
Author(s) -
Giannini Edoardo Giovanni,
Bucci Laura,
Garuti Francesca,
Brunacci Matteo,
Lenzi Barbara,
Valente Matteo,
Caturelli Eugenio,
Cabibbo Giuseppe,
Piscaglia Fabio,
Virdone Roberto,
Felder Martina,
Ciccarese Francesca,
Foschi Francesco Giuseppe,
Sacco Rodolfo,
Svegliati Baroni Gianluca,
Farinati Fabio,
Rapaccini Gian Lodovico,
Olivani Andrea,
Gasbarrini Antonio,
Di Marco Maria,
Morisco Filomena,
Zoli Marco,
Masotto Alberto,
Borzio Franco,
Benvegnù Luisa,
Marra Fabio,
Colecchia Antonio,
Nardone Gerardo,
Bernardi Mauro,
Trevisani Franco
Publication year - 2018
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29668
Subject(s) - medicine , hepatocellular carcinoma , sorafenib , liver cancer , gastroenterology , ascites , liver disease , population , stage (stratigraphy) , cirrhosis , paleontology , environmental health , biology
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. (H epatology 2018;67:1784‐1796).