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Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma
Author(s) -
Pecorelli Anna,
Lenzi Barbara,
Gramenzi Annagiulia,
Garuti Francesca,
Farinati Fabio,
Giannini Edoardo G.,
Ciccarese Francesca,
Piscaglia Fabio,
Rapaccini Gian Lodovico,
Di Marco Maria,
Caturelli Eugenio,
Zoli Marco,
Borzio Franco,
Sacco Rodolfo,
Cabibbo Giuseppe,
Felder Martina,
Morisco Filomena,
Gasbarrini Antonio,
Baroni Gianluca Svegliati,
Foschi Francesco G.,
Biasini Elisabetta,
Masotto Alberto,
Virdone Roberto,
Bernardi Mauro,
Trevisani Franco
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13242
Subject(s) - medicine , sorafenib , hepatocellular carcinoma , propensity score matching , gastroenterology , liver cancer , retrospective cohort study , liver function , stage (stratigraphy) , curative treatment , cohort , disease , paleontology , biology
Background & Aims The Barcelona Clinic Liver Cancer intermediate stage ( BCLC ‐B) of hepatocellular carcinoma ( HCC ) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial‐chemoembolization ( TACE ) is the first‐line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC ‐B patients and its outcome. Methods Retrospective analysis of 485 consecutive BCLC ‐B patients from the ITA . LI . CA database diagnosed with naïve HCC after 1999. Patients were stratified by treatment. Results 29 patients (6%) were lost to follow‐up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care ( BSC ) (21, 4.6%). Median survival (95% CI ) was 45 months (37.4–52.7) for curative treatments, 30 (24.7–35.3) for TACE , 14 (10.5–17.5) for sorafenib, 14 (5.2–22.7) for other treatments and 10 (6.0–14.2) for BSC ( P <.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality ( HR 0.197, 95% CI : 0.098–0.395) more than TACE ( HR 0.408, 95% CI : 0.211–0.789) ( P <.0001) as compared with BSC . Propensity score matching confirmed the superiority of curative therapies over TACE . Conclusions In everyday practice TACE represents the first‐line therapy in an half of patients with naïve BCLC ‐B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC ‐B patients and curative options offer the best outcome.