Alessandro Vitale1, Patrizia Burra2, Anna Chiara Frigo3, Franco Trevisani4, Fabio Farinati1, Gaya Spolverato1, Michael Volk5, Edoardo G Giannini6, Francesca Ciccarese7, Fabio Piscaglia8, Gian Lodovico Rapaccini9, Mariella Di Marco10, Eugenio Caturelli11, Marco Zoli8, Franco Borzio12, Giuseppe Cabibbo13, Martina Felder14, Antonio Gasbarrini15, Rodolfo Sacco16, Francesco Giuseppe Foschi17, Gabriele Missale18, Filomena Morisco19, Gianluca Svegliati Baroni20, Roberto Virdone21, Umberto Cillo1. 1. Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. 2. Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. Electronic address: burra@unipd.it. 3. Biostatistics Unit, University of Padua, Padua, Italy. 4. Department of Medical and Surgical Sciences, Division of Semeiotics, Alma Mater Studiorum - University of Bologna, Bologna, Italy. 5. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA. 6. Department of Internal Medicine, Division of Gastroenterology, University of Genova, Genova, Italy. 7. Division of Surgery, San Marco Hospital, Zingonia, Italy. 8. Department of Gastroenterology and Internal Medicine, Division of Internal Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy. 9. Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy. 10. Division of Medicine, Bolognini Hospital, Seriate, Italy. 11. Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy. 12. Department of Medicine, Division of Radiology, Fatebenefratelli Hospital, Milan, Italy. 13. Biomedical Department of Internal and Specialistic Medicine, Division of Gastroenterology, University of Palermo, Palermo, Italy. 14. Bolzano Regional Hospital, Division of Gastroenterology, Bolzano, Italy. 15. Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 16. Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy. 17. Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy. 18. Division of Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy. 19. Department of Medicine and Surgery, Division of Gastroenterology, University of Naples, "Federico II", Naples, Italy. 20. Division of Gastroenterology, Polytechnic University of Marche, Ancona, Italy. 21. Biomedical Department of Internal and Specialistic Medicine, Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Abstract
BACKGROUND & AIMS: The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. METHODS: Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection-MS LRT)/MS BSC. RESULTS: After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0=62% (40%, 82%), A=45% (13%, 65%), B=46% (9%, 76%), C=-16% (-55%, 33%). Model for end-stage liver disease (MELD) score>9, Child B class, and performance status (PST)=2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD⩽9 and PST<2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0=64% (44%, 85%), A=59% (45%, 74%), B=71% (52%, 90%), C=56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD>9 or PST=2 or Child B class), resection did not prove any survival benefit over LRT. CONCLUSIONS: Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD>9) and PST>1 are absent.
BACKGROUND & AIMS: The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. METHODS: Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCCpatients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection-MS LRT)/MS BSC. RESULTS: After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0=62% (40%, 82%), A=45% (13%, 65%), B=46% (9%, 76%), C=-16% (-55%, 33%). Model for end-stage liver disease (MELD) score>9, Child B class, and performance status (PST)=2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD⩽9 and PST<2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0=64% (44%, 85%), A=59% (45%, 74%), B=71% (52%, 90%), C=56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD>9 or PST=2 or Child B class), resection did not prove any survival benefit over LRT. CONCLUSIONS: Resection could result in survival benefit over LRT for HCCpatients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD>9) and PST>1 are absent.
Authors: Philipp Renner; Jürgen Schuhbaum; Alexander Kroemer; Florian Zeman; Martin Loss; Sven A Lang; Edward K Geissler; Hans J Schlitt; Stefan A Farkas Journal: Langenbecks Arch Surg Date: 2015-12-01 Impact factor: 3.445
Authors: Xavier Adhoute; Guillaume Penaranda; Jean Luc Raoul; Patrice Le Treut; Emilie Bollon; Jean Hardwigsen; Paul Castellani; Hervé Perrier; Marc Bourlière Journal: World J Hepatol Date: 2016-06-18