Brian I Carr1, Vito Guerra2, Rossella Donghia2, Fabio Farinati3, Edoardo G Giannini4, Luca Muratori5, Gian Ludovico Rapaccini6, Maria Di Marco7, Eugenio Caturelli8, Marco Zoli9, Rodolfo Sacco10, Ciro Celsa11, Claudia Campani12, Andrea Mega13, Maria Guarino14, Antonio Gasbarrini15, Gianluca Svegliati-Baroni16, Francesco Giuseppe Foschi17, Elisabetta Biasini18, Alberto Masotto19, Gerardo Nardone20, Giovanni Raimondo21, Francesco Azzaroli22, Gianpaolo Vidili23, Maurizia Rossana Brunetto24, Franco Trevisani25. 1. Translational HCC Research Department, Liver Transplant Institute, Inonu University, Malatya 44000, Turkey. 2. Clinical Trials Department, National Institute of Digestive Diseases, IRCCS S. de Bellis Research Hospital, 70013 Castellana Grotte, Italy. 3. Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy. 4. Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy. 5. Internal Medicine-Piscaglia Unit, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, 40138 Bologna, Italy. 6. Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy. 7. Medicine Unit, Bolognini Hospital, 24068 Seriate, Italy. 8. Gastroenterology Unit, Belcolle Hospital, 01100 Viterbo, Italy. 9. Department of Medical and Surgical Sciences, Internal Medicine-Zoli Unit, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy. 10. Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71122 Foggia, Italy. 11. Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, 90133 Palermo, Italy. 12. Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, 50121 Firenze, Italy. 13. Gastroenterology Unit, Bolzano Regional Hospital, 39100 Bolzano, Italy. 14. Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", 80138 Napoli, Italy. 15. Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, 00168 Roma, Italy. 16. Liver Injury and Transplant Unit, Polytechnic University of Marche, 60121 Ancona, Italy. 17. Department of Internal Medicine, Ospedale per gli Infermi of Faenza, 48018 Faenza, Italy. 18. Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy. 19. Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy. 20. Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", 37024 Napoli, Italy. 21. Department of Clinical and Experimental Medicine, Division of Medicine and Hepatology, University of Messina, 98122 Messina, Italy. 22. Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy. 23. Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria of Sassari, 07100 Sassari, Italy. 24. Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, 56126 Pisa, Italy. 25. IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. AIM: To examine patterns of tumor factors in large HCC patients. METHODS: A database of large HCC patients was examined. RESULTS: A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. CONCLUSIONS: Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.
BACKGROUND:Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. AIM: To examine patterns of tumor factors in large HCC patients. METHODS: A database of large HCC patients was examined. RESULTS: A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. CONCLUSIONS:Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.
Authors: Quirino Lai; Alessandro Vitale; Tommaso M Manzia; Francesco G Foschi; Giovanni B Levi Sandri; Martina Gambato; Fabio Melandro; Francesco P Russo; Luca Miele; Luca Viganò; Patrizia Burra; Edoardo G Giannini Journal: Cancers (Basel) Date: 2019-10-15 Impact factor: 6.639
Authors: Brian I Carr; Aldo Cavallini; Rosalba D'Alessandro; Maria Grazia Refolo; Catia Lippolis; Antonio Mazzocca; Caterina Messa Journal: BMC Cancer Date: 2014-01-27 Impact factor: 4.430