Pattern of macrovascular invasion in hepatocellular carcinoma

Antonio Gasbarrini, Mariateresa Guarino, Gian Ludovico Rapaccini, Maria Teresa Di Marco, Alessandra Forgione, Nicoletta De Matthaeis, Elena Armida Olivari, Francesco Conti, Monica Capasso, Alice Fiorentino, Maria Guarino, Alessandro Cucchetti, Giuseppina Pontillo, Fabio Farinati, Francesca Benevento, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Sacco Rodolfo, Giuseppe CabibboFabio Marra, Andrea Mega, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Gabriele Missale, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Filippo Oliveri, Franco Trevisani, Edoardo G. Giannini, Filomena Morisco, Maurizio Biselli, Paolo Caraceni, Francesca Garuti, Annagiulia Gramenzi, Andrea Neri, Davide Rampoldi, Valentina Santi, Antonella Forgione, Alessandro Granito, Luca Muratori, Fabio Piscaglia, Vito Sansone, Francesco Tovoli, Elton Dajti, Giovanni Marasco, Federico Ravaioli, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Ester Marina Cela, Antonio Facciorusso, Filippo Pelizzaro, Angela Imondi, Anna Sartori, Barbara Penzo, Valentina Cacciato, Edoardo Casagrande, Alessandro Moscatelli, Gaia Pellegatta, Giulia Pieri, Gloria Allegrini, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Andrea Olivari, Alessandro Inno, Fabiana Marchetti, Anita Busacca, Calogero Cammà, Vincenzo Di Martino, Giacomo Emanuele Maria Rizzo, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Dante Berardinelli, Giorgio Ercolani, Lucia Napoli, Claudia Campani, Chiara Di Bonaventura, Stefano Gitto, Pietro Coccoli, Antonio Malerba, Mario Capasso, Andrea Fiorentino, Luca Pignata, Valentina Cossiga, Veronica Romagnoli

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0 months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4 months in those with PS > 1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1 months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaEuropean Journal of Clinical Investigation
Volume51
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • cirrhosis
  • Tumor Burden
  • loco-regional treatment
  • portal vein thrombosis
  • surgery
  • transplantation
  • Ablation Techniques
  • Aged
  • Antineoplastic Agents
  • Ascites
  • Carcinoma, Hepatocellular
  • End Stage Liver Disease
  • Female
  • Hepatectomy
  • Hepatitis B, Chronic
  • Hepatitis C, Chronic
  • Humans
  • Italy
  • Liver Diseases, Alcoholic
  • Liver Neoplasms
  • Liver Transplantation
  • Male
  • Mesenteric Veins
  • Middle Aged
  • Neoplasm Invasiveness
  • Non-alcoholic Fatty Liver Disease
  • Patient Acuity
  • Portal Vein
  • Prognosis
  • Registries
  • Sorafenib
  • Survival Rate
  • hepatocellular carcinoma

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