Mauro Borzio1, Elena Dionigi1, Angelo Rossini2, Massimo Marignani3, Rodolfo Sacco4, Ilario De Sio5, Emanuela Bertolini6, Giampiero Francica7, Anna Giacomin8, Giancarlo Parisi9, Susanna Vicari10, Anna Toldi11, Andrea Salmi12, Sergio Boccia13, Mario Mitra14, Fabio Fornari15. 1. UOC Gastroenterologia ed Endoscopia Digestiva, ASST Melegnano e della Martesana, Milano, Italy. 2. Dipartimento di Medicina, SSVD di Epatologia, ASST Spedali Civili di Brescia, Brescia, Italy. 3. UOS Malattie delle vie Biliari e del Fegato, UOC malattie dell'Apparato Digerente e del Fegato, AO S. Andrea, Università Sapienza Roma, Roma, Italy. 4. UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy. 5. Unità di Gastroenterologia, Ospedale Policlinico, Napoli, Italy. 6. UO Medicina VI Epatologia e Gastroenterologia, Ospedale San Paolo, Università degli Studi di Milano, Milan, Italy. 7. Presidio Ospedaliero Pineta Grande, Unità di Ecointerventistica, Castel Volturno, Italy. 8. Dipartimento di Scienze Chirurgiche e Gastroenterologiche Ospedale Policlinico Padova, Padova, Italy. 9. Dipartimento di Medicina, Ospedale Santa Maria del Prato, Feltre, Italy. 10. UOS Gastroenterologia Ospedale di Bentivoglio, Bologna, Italy. 11. UO Gastroenterologia Ospedale Valduce, Como, Italy. 12. Dipartimento Medicina, Università di Verona, Verona, Italy. 13. UOC Gastroenterologia, Ospedale S. Anna, Ferrara, Italy. 14. UO Medicina Interna I, Ospedale Civico e Benfratelli, Palermo, Italy. 15. Unità di Gastroenterologia ed Epatologia, Ospedale G da Saliceto, Piacenza, Italy.
Abstract
Several staging systems for hepatocellular carcinoma (HCC) have been developed. The Barcelona Clinic Liver Cancer staging system is considered the best in predicting survival, although limitations have emerged. Recently, the Italian Liver Cancer (ITA.LI.CA) prognostic system, integrating ITA.LI.CA tumor staging (stages 0, A, B1-3, C) with the Child-Turcotte-Pugh score, Eastern Cooperative Oncology Group performance status, and alpha-fetoprotein with a strong ability to predict survival, was proposed. The aim of our study was to provide an external validation of the ITA.LI.CA system in an independent real-life occidental cohort of HCCs. From September 2008 to April 2016, 1,508 patients with cirrhosis and incident HCC were consecutively enrolled in 27 Italian institutions. Clinical, tumor, and treatment-related variables were collected, and patients were stratified according to scores of the Barcelona Clinic Liver Cancer system, ITA.LI.CA prognostic system, Hong Kong Liver Cancer system, Cancer of the Liver Italian Program, Japanese Integrated System, and model to estimate survival in ambulatory patients with hepatocellular carcinoma. Harrell's C-index, Akaike information criterion, and likelihood-ratio test were used to compare the predictive ability of the different systems. A subgroup analysis for treatment category (curative versus palliative) was performed. Median follow-up was 44 months (interquartile range, 23-63 months), and median overall survival was 34 months (interquartile range, 13-82 months). Median age was 71 years, and patients were mainly male individuals and hepatitis C virus carriers. According to ITA.LI.CA tumor staging, 246 patients were in stage 0, 472 were in stage A, 657 were in stages B1/3, and 133 were in stage C. The ITA.LI.CA prognostic system showed the best discriminatory ability (C-index = 0.77) and monotonicity of gradients compared to other systems, and its superiority was also confirmed after stratification for treatment strategy. CONCLUSION: This is the first study that independently validated the ITA.LI.CA prognostic system in a large cohort of Western patients with incident HCCs. The ITA.LI.CA system performed better than other multidimensional prognostic systems, even after stratification by curative or palliative treatment. This new system appears to be particularly useful for predicting individual HCC prognosis in clinical practice. (Hepatology 2018;67:2215-2225).
Several staging systems for hepatocellular carcinoma (HCC) have been developed. The Barcelona Clinic Liver Cancer staging system is considered the best in predicting survival, although limitations have emerged. Recently, the Italian Liver Cancer (ITA.LI.CA) prognostic system, integrating ITA.LI.CA tumor staging (stages 0, A, B1-3, C) with the Child-Turcotte-Pugh score, Eastern Cooperative Oncology Group performance status, and alpha-fetoprotein with a strong ability to predict survival, was proposed. The aim of our study was to provide an external validation of the ITA.LI.CA system in an independent real-life occidental cohort of HCCs. From September 2008 to April 2016, 1,508 patients with cirrhosis and incident HCC were consecutively enrolled in 27 Italian institutions. Clinical, tumor, and treatment-related variables were collected, and patients were stratified according to scores of the Barcelona Clinic Liver Cancer system, ITA.LI.CA prognostic system, Hong Kong Liver Cancer system, Cancer of the Liver Italian Program, Japanese Integrated System, and model to estimate survival in ambulatory patients with hepatocellular carcinoma. Harrell's C-index, Akaike information criterion, and likelihood-ratio test were used to compare the predictive ability of the different systems. A subgroup analysis for treatment category (curative versus palliative) was performed. Median follow-up was 44 months (interquartile range, 23-63 months), and median overall survival was 34 months (interquartile range, 13-82 months). Median age was 71 years, and patients were mainly male individuals and hepatitis C virus carriers. According to ITA.LI.CA tumor staging, 246 patients were in stage 0, 472 were in stage A, 657 were in stages B1/3, and 133 were in stage C. The ITA.LI.CA prognostic system showed the best discriminatory ability (C-index = 0.77) and monotonicity of gradients compared to other systems, and its superiority was also confirmed after stratification for treatment strategy. CONCLUSION: This is the first study that independently validated the ITA.LI.CA prognostic system in a large cohort of Western patients with incident HCCs. The ITA.LI.CA system performed better than other multidimensional prognostic systems, even after stratification by curative or palliative treatment. This new system appears to be particularly useful for predicting individual HCC prognosis in clinical practice. (Hepatology 2018;67:2215-2225).
Authors: Jan Bednarsch; Zoltan Czigany; Daniel Heise; Katharina Joechle; Tom Luedde; Lara Heij; Philipp Bruners; Tom Florian Ulmer; Ulf Peter Neumann; Sven Arke Lang Journal: Langenbecks Arch Surg Date: 2020-12-09 Impact factor: 3.445
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