Monofocal hepatocellular carcinoma: How much does size matter?. (23rd November 2020)

• Record Type: Journal Article
• Authors: Pelizzaro, Filippo; Penzo, Barbara; Peserico, Giulia; Imondi, Angela; Sartori, Anna; Vitale, Alessandro; Cillo, Umberto; Giannini, Edoardo G.; Forgione, Antonella; Ludovico Rapaccini, Gian; Di Marco, Maria; Caturelli, Eugenio; Zoli, Marco; Sacco, Rodolfo; Cabibbo, Giuseppe; Marra, Fabio; Mega, Andrea; Morisco, Filomena; Gasbarrini, Antonio; Svegliati‐Baroni, Gianluca; Giuseppe Foschi, Francesco; Olivani, Andrea; Masotto, Alberto; Nardone, Gerardo; Raimondo, Giovanni; Azzaroli, Francesco; Vidili, Gianpaolo; Oliveri, Filippo; Trevisani, Franco; Farinati, Fabio
• Other Names: Biselli Maurizio investigator.; Caraceni Paolo investigator.; Garuti Francesca investigator.; Gramenzi Annagiulia investigator.; Neri Andrea investigator.; Santi Valentina investigator.; Granito Alessandro investigator.; Muratori Luca investigator.; Piscaglia Fabio investigator.; Sansone Vito investigator.; Tovoli Francesco investigator.; Dajti Elton investigator.; Marasco Giovanni investigator.; Ravaioli Federico investigator.; Cappelli Alberta investigator.; Golfieri Rita investigator.; Mosconi Cristina investigator.; Renzulli Matteo investigator.; Sammarco Ambra investigator.; Cela Ester Marina investigator.; Facciorusso Antonio investigator.; Cacciato Valentina investigator.; Casagrande Edoardo investigator.; Moscatelli Alessandro investigator.; Pellegatta Gaia investigator.; de Matthaeis Nicoletta investigator.; Allegrini Gloria investigator.; Lauria Valentina investigator.; Ghittoni Giorgia investigator.; Pelecca Giorgio investigator.; Chegai Fabrizio investigator.; Coratella Fabio investigator.; Ortenzi Mariano investigator.; Missale Gabriele investigator.; Inno Alessandro investigator.; Marchetti Fabiana investigator.; Busacca Anita investigator.; Cabibbo Giuseppe investigator.; Cammà Calogero investigator.; Martino Vincenzo Di investigator.; Emanuele Maria Rizzo Giacomo investigator.; Franzè Maria Stella investigator.; Saitta Carlo investigator.; Sauchella Assunta investigator.; Bevilacqua Vittoria investigator.; Borghi Alberto investigator.; Casadei Gardini Andrea investigator.; Conti Fabio investigator.; Dall'Aglio Anna Chiara investigator.; Ercolani Giorgio investigator.; Mirici Federica investigator.; Campani Claudia investigator.; Bonaventura Chiara Di investigator.; Gitto Stefano investigator.; Coccoli Pietro investigator.; Malerba Antonio investigator.; Guarino Maria investigator.; Brunetto Maurizia investigator.; Romagnoli Veronica investigator.;
• Is Part Of: Liver international. Volume 41:Number 2(2021)
• Page Start: 396
• Page End: 407
• Publication Date: 2020-11-23
• Subjects: bclc staging system -- liver resection -- monofocal hepatocellular carcinoma -- prognosis -- treatment; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14718
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: 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.