Manuel Hernández-Guerra1, Alejandro Hernández-Camba2, Juan Turnes3, Luis Martin Ramos4, Laura Arranz2, José Mera3, Javier Crespo4, Enrique Quintero1. 1. Gastroenterology and Hepatology Unit, Hospital Universitario de Canarias, La Laguna, Spain ; Institute of Biomedical Technologies and Center of Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, La Laguna, Spain ; Department of Medicine and Psychiatry, Universidad de La Laguna, La Laguna, Spain. 2. Gastroenterology and Hepatology Unit, Hospital Universitario de Canarias, La Laguna, Spain. 3. Gastroenterology and Hepatology Unit, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain. 4. Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Abstract
BACKGROUND: The Barcelona Clinic Liver Cancer (BCLC) classification of hepatocellular carcinoma (HCC) has proved useful in the management of HCC patients. However, BCLC-recommended first-line treatment is not always applicable in clinical practice. OBJECTIVE: We performed a multicentre retrospective analysis of reasons for deviation from first-line treatment in 2008-2012. METHODS: One to three-year survival data were analysed using Kaplan-Meier method. RESULTS: A total of 407 consecutive HCC patients (66.6 ± 3 years, 83% male) with cirrhosis were included. Tumours were detected during surveillance in 53% of patients, grouped as Child-Pugh A (67%), B (25%) and C (8%); and BCLC A (including stage 0, 44%), B (26%), C (15%) and D (15%). In 31% of patients, first-line treatment was not feasible (51% in early stages) due to: technical reasons (74%); patient non-conformity (20%); medical decision (3%); and disease progression (3%). One to three-year survival of patients not receiving the recommended first-line treatment was similar to that of patients treated according to BCLC recommendations (log-rank, p = 0.229). CONCLUSION: In real-life practice one-third of HCC patients could not receive first-line BCLC treatment. In our cohort of patients, similar short and medium-term survival was observed. Long-term prospective studies are required to determine the best alternative treatment option when BCLC first-line treatment is not feasible.
BACKGROUND: The Barcelona Clinic Liver Cancer (BCLC) classification of hepatocellular carcinoma (HCC) has proved useful in the management of HCC patients. However, BCLC-recommended first-line treatment is not always applicable in clinical practice. OBJECTIVE: We performed a multicentre retrospective analysis of reasons for deviation from first-line treatment in 2008-2012. METHODS: One to three-year survival data were analysed using Kaplan-Meier method. RESULTS: A total of 407 consecutive HCC patients (66.6 ± 3 years, 83% male) with cirrhosis were included. Tumours were detected during surveillance in 53% of patients, grouped as Child-Pugh A (67%), B (25%) and C (8%); and BCLC A (including stage 0, 44%), B (26%), C (15%) and D (15%). In 31% of patients, first-line treatment was not feasible (51% in early stages) due to: technical reasons (74%); patient non-conformity (20%); medical decision (3%); and disease progression (3%). One to three-year survival of patients not receiving the recommended first-line treatment was similar to that of patients treated according to BCLC recommendations (log-rank, p = 0.229). CONCLUSION: In real-life practice one-third of HCC patients could not receive first-line BCLC treatment. In our cohort of patients, similar short and medium-term survival was observed. Long-term prospective studies are required to determine the best alternative treatment option when BCLC first-line treatment is not feasible.
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Authors: Francesca Romana Ponziani; Irene Spinelli; Emanuele Rinninella; Lucia Cerrito; Antonio Saviano; Alfonso Wolfango Avolio; Michele Basso; Luca Miele; Laura Riccardi; Maria Assunta Zocco; Brigida Eleonora Annicchiarico; Matteo Garcovich; Marco Biolato; Giuseppe Marrone; Anna Maria De Gaetano; Roberto Iezzi; Felice Giuliante; Fabio Maria Vecchio; Salvatore Agnes; Giovanni Addolorato; Massimo Siciliano; Gian Lodovico Rapaccini; Antonio Grieco; Antonio Gasbarrini; Maurizio Pompili Journal: World J Hepatol Date: 2017-12-28