Edoardo G Giannini1, Alessandro Moscatelli1, Gaia Pellegatta1, Alessandro Vitale2, Fabio Farinati3, Francesca Ciccarese4, Fabio Piscaglia5, Gian Lodovico Rapaccini6, Maria Di Marco7, Eugenio Caturelli8, Marco Zoli9, Franco Borzio10, Giuseppe Cabibbo11, Martina Felder12, Rodolfo Sacco13, Filomena Morisco14, Gabriele Missale15, Francesco Giuseppe Foschi16, Antonio Gasbarrini17, Gianluca Svegliati Baroni18, Roberto Virdone19, Alberto Masotto20, Franco Trevisani21. 1. Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy. 2. Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Chirurgia Epatobiliare e dei Trapianti Epatici, Università di Padova, Padova, Italy. 3. Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Padova, Italy. 4. Divisione di Chirurgia, Policlinico San Marco, Zingonia, Italy. 5. Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina, Alma Mater Studiorum-Università di Bologna, Bologna, Italy. 6. Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Roma, Italy. 7. Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy. 8. Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy. 9. Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy. 10. Dipartimento di Medicina, Unità di Radiologia, Ospedale Fatebenefratelli, Milano, Italy. 11. Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Gastroenterologia, Università di Palermo, Palermo, Italy. 12. Ospedale Regionale di Bolzano, Unità di Gastroenterologia, Bolzano, Italy. 13. Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 14. Dipartimento di Medicina Clinica e Chirurgia, Unità di Gastroenterologia, Università di Napoli 'Federico II', Napoli, Italy. 15. Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 16. Dipartimento di Medicina Interna, Ospedale per gli Infermi di Faenza, Faenza, Italy. 17. Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Roma, Italy. 18. Clinica di Gastroenterologia, Università Politecnica delle Marche, Ancona, Italy. 19. Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Interna 2, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. 20. Unità di Gastroenterologia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy. 21. Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
Abstract
OBJECTIVES: The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group. METHODS: We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages. RESULTS: Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P<0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P<0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P<0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival. CONCLUSIONS: The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients.
OBJECTIVES: The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group. METHODS: We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages. RESULTS: Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P<0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P<0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P<0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival. CONCLUSIONS: The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients.
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