6533b820fe1ef96bd127a576
RESEARCH PRODUCT
Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma.
Pecorelli ALenzi BGramenzi AGaruti FFarinati FGiannini EgCiccarese FPiscaglia FRapaccini GlDi Marco MCaturelli EZoli MBorzio FSacco RCabibbo GFelder MMorisco FGasbarrini ABaroni GsFoschi FgBiasini EMasotto AVirdone RBernardi MTrevisani FBolondi LBiselli MBucci LCaraceni PCucchetti ADomenicali MVenerandi LGiacomin AMaddalo GPozzan CVani VPoggio PdOlmi SBalsamo CVavassori EBenvegnù LCappelli AGolfieri RMosconi CRenzulli MBosco GRoselli PDell'isola SIalungo AmBruzzone LPicciotto AMarenco SRisso DSammito GSavarino VCammà CMaida MCostantino ABarcellona MrAffronti AMega ARinninella EMismas VCappa FmDall'aglio AcFeletti VLanzi ANeri EStefanini GfTamberi SMissale GPorro EGuarino MGemini SSchiadà LFor The Italian Livercancer (Ita. Li. Ca) Group (Donatella MagalottiCarla Serrasubject
SorafenibMaleNiacinamidemedicine.medical_specialtyStandard of careCarcinoma HepatocellularAntineoplastic AgentsGastroenterologyIntermediate stage03 medical and health sciences0302 clinical medicineHCC; BCLC-B; Intermediate stage; Treatment; HepatologyInternal medicinemedicineHumansChemoembolization TherapeuticHCCPropensity ScoreAgedNeoplasm StagingRetrospective Studiesintermediate stageHepatologytreatmentbusiness.industryPatient SelectionPhenylurea CompoundsLiver NeoplasmsSettore MED/09 - MEDICINA INTERNAStandard of CareHepatologyMiddle AgedSorafenibmedicine.diseaseSurvival AnalysisTreatment OutcomeItaly030220 oncology & carcinogenesisHepatocellular carcinomaPropensity score matchingMultivariate Analysis030211 gastroenterology & hepatologyFemaleLiver functionLiver cancerbusinessBCLC-Bmedicine.drugdescription
Background and aims the Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumor burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. Methods retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naive HCC after 1999. Patients were stratified by treatment. Results 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (p<0.0001). Independent prognosticators were sex and treatment. Curative treatments reduced mortality (HR 0.197,95%CI 0.098-0.395) more than TACE (HR 0.408,95%CI 0.211-0.789) (p<0.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. Conclusions in everyday practice TACE represents the first-line therapy in an half of patients with naive BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-Bpatients and curative options offer the best outcome. This article is protected by copyright. All rights reserved.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-01-01 |