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Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice

2017; Lippincott Williams & Wilkins; Volume: 67; Issue: 5 Linguagem: Inglês

10.1002/hep.29668

1527-3350

Edoardo G. Giannini, Laura Bucci, Francesca Garuti, Matteo Brunacci, B. Lenzi, Matteo Valente, Eugenio Caturelli, Giuseppe Cabibbo, Fabio Piscaglia, Roberto Virdone, Martina Felder, Francesca Ciccarese, Francesco Giuseppe Foschi, Rodolfo Sacco, Gianluca Svegliati‐Baroni, Fabio Farinati, Gian Lodovico Rapaccini, Andrea Olivani, Antonio Gasbarrini, Maria Di Marco, Filomena Morisco, Marco Zoli, Alberto Masotto, Franco Borzio, Luisa Benvegnù, Fabio Marra, Antonio Colecchia, Gerardo Nardone, Mauro Bernardi, Franco Trevisani,

Cholangiocarcinoma and Gallbladder Cancer Studies

The Barcelona Clinic Liver Cancer (BCLC) advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study, our aim was to assess treatment and overall survival (OS) of BCLC C patients subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified as: PS1 alone (n = 385; 46.1%), PS2 alone (n = 146; 17.5%), MVI (n = 224; 26.8%), EHS (n = 51; 6.1%), and MVI + EHS (n = 29; 3.5%). MVI, EHS, and MVI + EHS patients had larger and multifocal/massive HCCs and higher alpha‐fetoprotein (AFP) levels than PS1 and PS2 patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months), and MVI + EHS (3.1 months; P < 0.001). Among MVI patients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHS patients (51.7%). Independent prognostic factors were: Model for End‐stage Liver Disease score, Child‐Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type. Conclusion: BCLC C stage does not identify patients homogeneous enough to be allocated to a single stage. PS1 alone is not sufficient to include a patient into this stage. The remaining patients should be subclassified according to PS and tumor features, and new patient‐tailored therapeutic indications are needed. (H epatology 2018;67:1784‐1796).