Portal de Periódicos da CAPES

Impact of evidence‐based medicine on the treatment of patients with unresectable hepatocellular carcinoma

2009; Wiley; Volume: 31; Issue: 4 Linguagem: Inglês

10.1111/j.1365-2036.2009.04198.x

1365-2036

Edoardo G. Giannini, Giorgia Bodini, Massimo Corbo, Vincenzo Savarino, Domenico Risso, Maria Anna Di Nolfo, P. Del Poggio, Luisa Benvegnù, Fabio Farinati, Marco Zoli, Franco Borzio, Eugenio Caturelli, M. Chiaramonte, Franco Trevisani,

Hepatitis C virus research

A randomized controlled trial performed by the Barcelona Clinic Liver Cancer (BCLC) published in 2002 demonstrated that transcatheter arterial chemoembolisation (TACE) is an effective treatment for well-selected patients with unresectable hepatocellular carcinoma (HCC).To access whether this information has modified the use of TACE in clinical practice.From 2042 HCC patients included in the Italian Liver Cancer database, we selected 336 cases diagnosed over two 4-year periods (1999-2002, n = 161 and 2003-2006, n = 175), fulfilling the inclusion criteria of the BCLC study. These groups were compared for TACE application rate, patient characteristics and survival.Patients undergoing TACE increased in the 2003-2006 period (from 62% to 73%, P = 0.035), with an increase in of Child-Pugh class A (from 64% to 77%, P = 0.048) and advanced HCC patients (from 54% to 69%, P = 0.041). In the 1999-2002 period, there was no significant difference in survival between TACE-treated and untreated patients, while in the 2003-2006 period, TACE-treated patients survived longer (P < 0.0001).Following the publication of studies providing evidence of a survival benefit of TACE in selected patients with unresectable HCC, significantly more patients with well-compensated cirrhosis underwent TACE within this very homogenous population, leading to an increased survival despite a more advanced tumour stage.