6533b861fe1ef96bd12c5a9d

RESEARCH PRODUCT

Monofocal hepatocellular carcinoma: How much does size matter?

Filippo PelizzaroBarbara PenzoGiulia PesericoAngela ImondiAnna SartoriAlessandro VitaleUmberto CilloEdoardo GianniniAntonella ForgioneGian Ludovico RapacciniMaria Di MarcoEugenio CaturelliMarco ZoliRodolfo SaccoGiuseppe CabibboFabio MarraAndrea MegaFilomena MoriscoAntonio GasbarriniGianluca Svegliati‐baroniFrancesco Giuseppe FoschiAndrea OlivaniAlberto MasottoGerardo NardoneGiovanni RaimondoFrancesco AzzaroliGianpaolo VidiliFilippo OliveriFranco TrevisaniFabio FarinatiMaurizio BiselliPaolo CaraceniFrancesca GarutiAnnagiulia GramenziAndrea NeriValentina SantiAlessandro GranitoLuca MuratoriFabio PiscagliaVito SansoneFrancesco TovoliElton DajtiGiovanni MarascoFederico RavaioliAlberta CappelliRita GolfieriCristina MosconiMatteo RenzulliAmbra SammarcoEster Marina CelaAntonio FacciorussoValentina CacciatoEdoardo CasagrandeAlessandro MoscatelliGaia PellegattaNicoletta De MatthaeisGloria AllegriniValentina LauriaGiorgia GhittoniGiorgio PeleccaFabrizio ChegaiFabio CoratellaMariano OrtenziGabriele MissaleAlessandro InnoFabiana MarchettiAnita BusaccaGiuseppe CabibboCalogero CammàVincenzo Di MartinoGiacomo Emanuele Maria RizzoMaria Stella FranzèCarlo SaittaAssunta SauchellaVittoria BevilacquaAlberto BorghiAndrea Casadei GardiniFabio ContiAnna Chiara Dall'aglioGiorgio ErcolaniFederica MiriciClaudia CampaniChiara Di BonaventuraStefano GittoPietro CoccoliAntonio MalerbaMaria GuarinoMaurizia BrunettoVeronica Romagnoli

subject

medicine.medical_specialtyMultivariate analysisCarcinoma HepatocellularIndependent predictorGastroenterologyResection03 medical and health sciences0302 clinical medicineInternal medicinemedicineOverall survivalHepatectomyHumansStaging systemNeoplasm StagingRetrospective StudiesSettore MED/12 - GastroenterologiaHepatologytreatmentbusiness.industrySettore MED/09 - MEDICINA INTERNALiver Neoplasmsbclc staging systemmonofocal hepatocellular carcinomamedicine.diseasedigestive system diseasesSurvival benefitItaly030220 oncology & carcinogenesisHepatocellular carcinomabclc staging system; liver resection; monofocal hepatocellular carcinoma; prognosis; treatmentliver resection030211 gastroenterology & hepatologyprognosisbusinessLiver cancerprognosi

description

Background & Aims: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5 cm) monofocal (HCC). Methods: From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5 cm; SEM-HCC), 163 patients with larger tumours (>5 cm; LEM-HCC) and 1048 intermediate stage patients (BCLC B). Results: LEM-HCC patients had a worse overall survival (OS) than SEM-HCC (31.0 vs 49.0 months; P <.0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29-2.05; P <.0001). The small difference in OS between LEM-HCC and BCLC B patients (31.0 vs 27.0 months; P =.03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77-1.25; P =.89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from “curative” to “palliative” therapies. The survival of resected patients with LEM-HCC was significantly shorter than that of SEM-HCC (44.0 vs 78.0 months; P =.002), but liver resection provided the highest survival benefit in both groups compared to other treatments. Conclusions: Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients.

10.1111/liv.14718http://hdl.handle.net/11585/800061