Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma. (2nd October 2016)

• Record Type: Journal Article
• Authors: Pecorelli, Anna; Lenzi, Barbara; Gramenzi, Annagiulia; Garuti, Francesca; Farinati, Fabio; Giannini, Edoardo G.; Ciccarese, Francesca; Piscaglia, Fabio; Rapaccini, Gian Lodovico; Di Marco, Maria; Caturelli, Eugenio; Zoli, Marco; Borzio, Franco; Sacco, Rodolfo; Cabibbo, Giuseppe; Felder, Martina; Morisco, Filomena; Gasbarrini, Antonio; Baroni, Gianluca Svegliati; Foschi, Francesco G.; Biasini, Elisabetta; Masotto, Alberto; Virdone, Roberto; Bernardi, Mauro; Trevisani, Franco
• Other Names: Bolondi Luigi investigator.; Biselli Maurizio investigator.; Bucci Laura investigator.; Caraceni Paolo investigator.; Cucchetti Alessandro investigator.; Domenicali Marco investigator.; Magalotti Donatella investigator.; Serra Carla investigator.; Venerandi Laura investigator.; Giacomin Anna investigator.; Maddalo Gemma investigator.; Pozzan Caterina investigator.; Vani Veronica investigator.; Poggio Paolo Del investigator.; Olmi Stefano investigator.; Balsamo Claudia investigator.; Vavassori Elena investigator.; Benvegnù Luisa investigator.; Cappelli Alberta investigator.; Golfieri Rita investigator.; Mosconi Cristina investigator.; Renzulli Matteo investigator.; Bosco Giulia investigator.; Roselli Paola investigator.; Dell'Isola Serena investigator.; Ialungo Anna Maria investigator.; Bruzzone Linda investigator.; Picciotto Antonino investigator.; Marenco Simona investigator.; Risso Domenico investigator.; Sammito Giorgio investigator.; Savarino Vincenzo investigator.; Cammà Calogero investigator.; Maida Marcello investigator.; Costantino Andrea investigator.; Barcellona Maria Rosa investigator.; Affronti Andrea investigator.; Mega Andrea investigator.; Rinninella Emanuele investigator.; Mismas Valeria investigator.; Cappa Federica Mirici investigator.; Dall'Aglio Anna Chiara investigator.; Feletti Valentina investigator.; Lanzi Arianna investigator.; Neri Elga investigator.; Stefanini Giuseppe Francesco investigator.; Tamberi Stefano investigator.; Missale Gabriele investigator.; Porro Emanuela investigator.; Guarino Maria investigator.; Gemini Stefano investigator.; Schiadà Laura investigator.;
• Is Part Of: Liver international. Volume 37:Number 3(2017)
• Page Start: 423
• Page End: 433
• Publication Date: 2016-10-02
• Subjects: BCLC‐B -- HCC -- intermediate stage -- treatment; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.13242
• Languages: English
• ISSNs: 1478-3223

Abstract

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.