TY - JOUR
T1 - Reverse time-dependent effect of alphafetoprotein and disease control on survival of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma
AU - Ponziani, Francesca Romana
AU - Spinelli, Irene
AU - Rinninella, Emanuele
AU - Cerrito, Lucia
AU - Saviano, Antonio
AU - Avolio, Alfonso Wolfango
AU - Basso, Michele
AU - Miele, Luca
AU - Riccardi, Laura
AU - Zocco, Maria Assunta
AU - Annicchiarico, Brigida Eleonora
AU - Garcovich, Matteo
AU - Biolato, Marco
AU - Marrone, Giuseppe
AU - De Gaetano, Anna Maria
AU - Iezzi, Roberto
AU - Giuliante, Felice
AU - Vecchio, Fabio Maria
AU - Agnes, Salvatore
AU - Addolorato, Giovanni
AU - Siciliano, Massimo
AU - Rapaccini, Gian Lodovico
AU - Grieco, Antonio
AU - Gasbarrini, Antonio
AU - Pompili, Maurizio
PY - 2017
Y1 - 2017
N2 - AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) and to ascertain the factors predicting the achievement of disease control (DC). METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo (95%CI: 10.6-17.0). Only alphafetoprotein (AFP) serum level > 200 ng/mL and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up (HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year (HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC (OR = 0.263, 95%CI: 0.111-0.622, P = 0.002). CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.
AB - AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) and to ascertain the factors predicting the achievement of disease control (DC). METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo (95%CI: 10.6-17.0). Only alphafetoprotein (AFP) serum level > 200 ng/mL and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up (HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year (HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC (OR = 0.263, 95%CI: 0.111-0.622, P = 0.002). CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.
KW - Alphafetoprotein
KW - Barcelona Clinic Liver Cancer stage C
KW - Cirrhosis
KW - Disease control
KW - Hepatocellular carcinoma
KW - Hepatology
KW - Performance status
KW - Survival
KW - Alphafetoprotein
KW - Barcelona Clinic Liver Cancer stage C
KW - Cirrhosis
KW - Disease control
KW - Hepatocellular carcinoma
KW - Hepatology
KW - Performance status
KW - Survival
UR - http://hdl.handle.net/10807/112293
UR - https://f6publishing.blob.core.windows.net/cf0bd2a1-802f-4805-a035-178e9f088ee3/wjh-9-1322.pdf
U2 - 10.4254/wjh.v9.i36.1322
DO - 10.4254/wjh.v9.i36.1322
M3 - Article
VL - 9
SP - 1322
EP - 1331
JO - World Journal of Hepatology
JF - World Journal of Hepatology
SN - 1948-5182
ER -