Edoardo Giovanni Giannini1, Laura Bucci2, Francesca Garuti2, Matteo Brunacci1, Barbara Lenzi2, Matteo Valente2, Eugenio Caturelli3, Giuseppe Cabibbo4, Fabio Piscaglia5, Roberto Virdone6, Martina Felder7, Francesca Ciccarese8, Francesco Giuseppe Foschi9, Rodolfo Sacco10, Gianluca Svegliati Baroni11, Fabio Farinati12, Gian Lodovico Rapaccini13, Andrea Olivani14, Antonio Gasbarrini15, Maria Di Marco16, Filomena Morisco17, Marco Zoli18, Alberto Masotto19, Franco Borzio20, Luisa Benvegnù21, Fabio Marra22, Antonio Colecchia23, Gerardo Nardone24, Mauro Bernardi2, Franco Trevisani2. 1. Department of Internal Medicine, Gastroenterology Unit, San Martino Polyclinic, University of Genova, Genova, Italy. 2. Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 3. Operative Unit of Gastroenterology, Belcolle Hospital, Viterbo, Italy. 4. Biomedical Department of Internal and Specialistic Medicine, Gastroenterology, Palermo, Italy. 5. Department of Medical and Surgical Sciences, Internal Medicine Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 6. Biomedical Department of Internal and Specialistic Medicine, Internal Medicin 2 Unit, Villa Sofia Hospital Agency Riuniti Hospitals-Cervello, Palermo, Italy. 7. Gastroenterology, Physiopathology and Digestive Endoscopy, Central Hospital of Bolzano, Bolzano, Italy. 8. Surgery Division, San Marco Polyclinic, Zingonia, Italy. 9. Department of Internal Medicine, Infermi Hospital of Faenza, Faenza, Italy. 10. Gastroenterology and Metabolic Diseases Unit, Hospital-University Agency of Pisa, Pisa, Italy. 11. Department of Gastroenterology, Gastroenterology, Polytechnic-University of Marche, Ancona, Italy. 12. Department of Surgical and Gastroenterological Sciences, Gastroenterology, University of Padova, Italy. 13. Department of Internal Medicine, Cattolica University of Rome, Rome, Italy. 14. Department of Oncohematology and Internal Medicine, Infection diseases and Hepatology Unit, Parma, Italy. 15. Internal Medicine and Gastroenterology Unit-Gemelli, Department of Internal Medicine, Rome, Italy. 16. Medicine Division, Bolognini Hospital Agency, Seriate, Italy. 17. Gastroenterology Unit, Department of Clinical and Sperimental Medicine, Naples, Italy. 18. Department of Medical and Surgical Sciences, Zoli Internal Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 19. Gastroenterology, Sacro Cuore Don Calabria Hospital, Negrar, Italy. 20. Department of Internal Medicine and Hepatology, Fatebenefratelli Hospital, Milan, Italy. 21. Department of Molecular Medicine, University of Padova, Padova, Italy. 22. Internal Medicine and Hepatology, Department of Sperimental and Clinical Medicine, Florence, Italy. 23. Department of Medical and Surgical Sciences, Gastroenterology Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 24. Department of Clinical and Surgical Medicine-Federico II University, Naples, Italy.
Abstract
The Barcelona Clinic Liver Cancer (BCLC) advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study, our aim was to assess treatment and overall survival (OS) of BCLC C patients subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified as: PS1 alone (n = 385; 46.1%), PS2 alone (n = 146; 17.5%), MVI (n = 224; 26.8%), EHS (n = 51; 6.1%), and MVI + EHS (n = 29; 3.5%). MVI, EHS, and MVI + EHS patients had larger and multifocal/massive HCCs and higher alpha-fetoprotein (AFP) levels than PS1 and PS2 patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months), and MVI + EHS (3.1 months; P < 0.001). Among MVI patients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHS patients (51.7%). Independent prognostic factors were: Model for End-stage Liver Disease score, Child-Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type. CONCLUSION: BCLC C stage does not identify patients homogeneous enough to be allocated to a single stage. PS1 alone is not sufficient to include a patient into this stage. The remaining patients should be subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796).
The Barcelona Clinic Liver Cancer (BCLC) advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study, our aim was to assess treatment and overall survival (OS) of BCLC C patients subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified as: PS1 alone (n = 385; 46.1%), PS2 alone (n = 146; 17.5%), MVI (n = 224; 26.8%), EHS (n = 51; 6.1%), and MVI + EHS (n = 29; 3.5%). MVI, EHS, and MVI + EHSpatients had larger and multifocal/massive HCCs and higher alpha-fetoprotein (AFP) levels than PS1 and PS2patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months), and MVI + EHS (3.1 months; P < 0.001). Among MVIpatients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHSpatients (51.7%). Independent prognostic factors were: Model for End-stage Liver Disease score, Child-Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type. CONCLUSION: BCLC C stage does not identify patients homogeneous enough to be allocated to a single stage. PS1 alone is not sufficient to include a patient into this stage. The remaining patients should be subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796).
Authors: Gauri Mishra; Ammar Majeed; Anouk Dev; Guy D Eslick; David J Pinato; Hirofumi Izumoto; Atsushi Hiraoka; Teh-Ia Huo; Po-Hong Liu; Philip J Johnson; Stuart K Roberts Journal: J Gastrointest Cancer Date: 2022-05-30
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Authors: Giovanni Marasco; Francesco Poggioli; Antonio Colecchia; Giuseppe Cabibbo; Filippo Pelizzaro; Edoardo Giovanni Giannini; Sara Marinelli; Gian Ludovico Rapaccini; Eugenio Caturelli; Mariella Di Marco; Elisabetta Biasini; Fabio Marra; Filomena Morisco; Francesco Giuseppe Foschi; Marco Zoli; Antonio Gasbarrini; Gianluca Svegliati Baroni; Alberto Masotto; Rodolfo Sacco; Giovanni Raimondo; Francesco Azzaroli; Andrea Mega; Gianpaolo Vidili; Maurizia Rossana Brunetto; Gerardo Nardone; Luigina Vanessa Alemanni; Elton Dajti; Federico Ravaioli; Davide Festi; Franco Trevisani; On Behalf Of The Italian Liver Cancer Ita Li Ca Group Journal: Cancers (Basel) Date: 2021-05-29 Impact factor: 6.639