Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

Antonio Gasbarrini, Anna Pecorelli, Barbara Lenzi, Annagiulia Gramenzi, Francesca Garuti, Fabio Farinati, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Rodolfo Sacco, Giuseppe Cabibbo, Martina Felder, Filomena Morisco, Gianluca Svegliati Baroni, Francesco G. Foschi, Elisabetta BiasiniAlberto Masotto, Roberto Virdone, Mauro Bernardi, Franco Trevisani, Luigi Bolondi, Maurizio Biselli, Laura Bucci, Paolo Caraceni, Alessandro Cucchetti, Marco Domenicali, Donatella Magalotti, Carla Serra, Laura Venerandi, Anna Giacomin, Gemma Maddalo, Caterina Pozzan, Veronica Vani, Paolo Del Poggio, Stefano Olmi, Claudia Balsamo, Elena Vavassori, Luisa Benvegnù, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Giulia Bosco, Paola Roselli, Serena Dell'Isola, Anna Maria Ialungo, Linda Bruzzone, Antonino Picciotto, Simona Marenco, Domenico Risso, Giorgio Sammito, Vincenzo Savarino, Calogero Cammà, Marcello Maida, Andrea Costantino, Maria Rosa Barcellona, Andrea Affronti, Andrea Mega, Emanuele Rinninella, Valeria Mismas, Federica Mirici Cappa, Anna Chiara Dall'Aglio, Valentina Feletti, Arianna Lanzi, Elga Neri, Giuseppe Francesco Stefanini, Stefano Tamberi, Gabriele Missale, Emanuela Porro, Maria Guarino, Stefano Gemini, Laura Schiadà

Risultato della ricerca: Contributo in rivistaArticolo in rivista

30 Citazioni (Scopus)

Abstract

Background & Aims: The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour 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 naïve 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<.0001). Independent prognosticators were gender 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<.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 naïve 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-B patients and curative options offer the best outcome.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaLiver International
DOI
Stato di pubblicazionePubblicato - 2016

Keywords

  • BCLC-B
  • HCC
  • Hepatology
  • Intermediate stage
  • Treatment

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