Maria Guarino1, Raffaella Tortora2, Giorgio de Stefano3, Carmine Coppola4, Filomena Morisco1, Angelo Salomone Megna5, Francesco Izzo6, Gerardo Nardone1, Guido Piai7, Luigi Elio Adinolfi8, Giuseppe D'Adamo9, Giovanni Battista Gaeta10, Vincenzo Messina11, Giampiero Francica12, Vincenzo De Girolamo13, Nicola Coppola14, Marcello Persico15, Giovan Giuseppe Di Costanzo2. 1. Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. 2. Hepatology Unit, "Cardarelli" Hospital, Naples, Italy. 3. IX Interventional Ultrasound Unit for Infectious Diseases, AORN dei Colli, P.O. Cotugno, Naples, Italy. 4. Liver Unit, Gragnano Hospital, Gragnano (NA), Italy. 5. Division of Infectious Diseases, Rummo Hospital, Benevento, Italy. 6. Department of Abdominal Surgical Oncology and Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy. 7. Unit for Liver Transplant Management, Department of Medical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy. 8. Department of Medical, Surgical, Neurological, Geriatric and Metabolic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. 9. Internal Medicine Unit, A.O. Nocera, Nocera (Salerno), Italy. 10. Second University of Naples, Infectious Diseases and Viral Hepatitis Unit, Naples, Italy. 11. Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy. 12. Interventional Ultrasound Unit, Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy. 13. Gastroenterology Unit, PSI Napoli EST - ASL NA 1, Naples, Italy. 14. Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy. 15. Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Abstract
BACKGROUND AND AIM: The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival. METHODS: We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers. RESULTS: Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha-fetoprotein > 200 ng/mL, more early-stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B and C, and the presence of neoplastic thrombosis and metastases. CONCLUSION: Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.
BACKGROUND AND AIM: The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhoticpatients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival. METHODS: We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhoticpatients, prospectively collected from January 2013 to December 2015 in 16 regional centers. RESULTS: Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha-fetoprotein > 200 ng/mL, more early-stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B and C, and the presence of neoplastic thrombosis and metastases. CONCLUSION: Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.
Authors: Filippo Pelizzaro; Selion Haxhi; Barbara Penzo; Alessandro Vitale; Edoardo G Giannini; Vito Sansone; Gian Ludovico Rapaccini; Maria Di Marco; Eugenio Caturelli; Donatella Magalotti; Rodolfo Sacco; Ciro Celsa; Claudia Campani; Andrea Mega; Maria Guarino; Antonio Gasbarrini; Gianluca Svegliati-Baroni; Francesco Giuseppe Foschi; Andrea Olivani; Alberto Masotto; Gerardo Nardone; Giovanni Raimondo; Francesco Azzaroli; Gianpaolo Vidili; Maurizia Rossana Brunetto; Franco Trevisani; Fabio Farinati Journal: Front Oncol Date: 2022-01-31 Impact factor: 6.244