Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: A multicentre, cohort study

Alessandro Vitale, Rafael Ramirez Morales, Giacomo Zanus, Fabio Farinati, Patrizia Burra, Paolo Angeli, Anna Chiara Frigo, Paolo Del Poggio, Gianludovico Rapaccini, Maria Anna Di Nolfo, Luisa Benvegnù, Marco Zoli, Franco Borzio, Edoardo Giovanni Giannini, Eugenio Caturelli, Maria Chiaramonte, Franco Trevisani, Umberto Cillo

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Abstract

Background: Allocation of deceased-donor livers to patients with chronic liver failure is improved by prioritising patients by 5-year liver transplantation survival benefit. The Barcelona Clinic Liver Cancer (BCLC) staging has been proposed as the standard means to assess for prognosis of patients with hepatocellular carcinoma. We aimed to create a prediction model linking the BCLC stage of patients with hepatocellular carcinoma to their 5-year liver transplant benefit. Methods: A large cohort of consecutive patients with hepatocellular carcinoma (n=1328) from the ITA.LI.CA database (n=2951) were judged as potentially eligible for liver transplantation according to the following criteria: absence of macroscopic vascular invasion or metastases, age 70 years or younger, and absence of relevant extra-hepatic comorbidities. To assess the correlation between BCLC staging and non-liver transplantation survival, we did Cox univariate and multivariate analyses including the following covariates: BCLC stage, year of diagnosis, age, sex, cause of cirrhosis, model for end-stage liver disease score, α-fetoprotein concentrations, and treatment. Liver-transplantation survival benefit for patients was calculated, using Monte Carlo simulation analysis, as the patient's 5-year life expectancy with liver transplantation (estimated by the Metroticket model) minus the 5-year life expectancy without liver transplantation according to BCLC stage. Findings: 83 (6%) of 1328 patients had BCLC 0 stage disease, 614 (46%) had BCLC A, 500 (38%) had BCLC B-C, and 131 (10%) had BCLC D. In the Cox non-liver transplantation survival multivariate model, hazard ratios associated with increasing BCLC stages were 1·530 (95% CI 1·107-2·116) for BCLC A versus BCLC 0, 1·572 (1·350-1·830) for BCLC B-C versus BCLC A, and 1·470 (1·164-1·856) for BCLC D versus BCLC B-C. Results of the Monte Carlo simulation analysis confirmed the significant effect of BCLC classification on transplant benefit; in the adjusted model, a median 5-year transplant benefit of 11·19 months (IQR 10·73-11·67) for BCLC 0, 13·49 months (11·51-15·57) for BCLC A, 17·36 months (15·06-19·28) for BCLC B-C, and 28·46 months (26·38-30·34) for BCLC D. Interpretation: Liver transplantation could result in survival benefit for patients with hepatocellular carcinoma and advanced liver cirrhosis (BCLC stage D) and in those with intermediate tumours (BCLC stages B-C), regardless of the nodule number-size criteria (ie, Milan criteria), provided that macroscopic vascular invasion and extra-hepatic disease are absent. Funding: None.

Original languageEnglish
Pages (from-to)654-662
Number of pages9
JournalThe Lancet Oncology
Volume12
Issue number7
DOIs
Publication statusPublished - Jul 2011

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Neoplasm Staging
Liver Neoplasms
Multicenter Studies
Hepatocellular Carcinoma
Cohort Studies
Transplants
Liver Transplantation
Survival
End Stage Liver Disease
Liver
Life Expectancy
Blood Vessels
Transplantation
Fetal Proteins

ASJC Scopus subject areas

  • Oncology

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Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma : A multicentre, cohort study. / Vitale, Alessandro; Morales, Rafael Ramirez; Zanus, Giacomo; Farinati, Fabio; Burra, Patrizia; Angeli, Paolo; Frigo, Anna Chiara; Del Poggio, Paolo; Rapaccini, Gianludovico; Di Nolfo, Maria Anna; Benvegnù, Luisa; Zoli, Marco; Borzio, Franco; Giannini, Edoardo Giovanni; Caturelli, Eugenio; Chiaramonte, Maria; Trevisani, Franco; Cillo, Umberto.

In: The Lancet Oncology, Vol. 12, No. 7, 07.2011, p. 654-662.

Research output: Contribution to journalArticle

Vitale, A, Morales, RR, Zanus, G, Farinati, F, Burra, P, Angeli, P, Frigo, AC, Del Poggio, P, Rapaccini, G, Di Nolfo, MA, Benvegnù, L, Zoli, M, Borzio, F, Giannini, EG, Caturelli, E, Chiaramonte, M, Trevisani, F & Cillo, U 2011, 'Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: A multicentre, cohort study', The Lancet Oncology, vol. 12, no. 7, pp. 654-662. https://doi.org/10.1016/S1470-2045(11)70144-9
Vitale, Alessandro ; Morales, Rafael Ramirez ; Zanus, Giacomo ; Farinati, Fabio ; Burra, Patrizia ; Angeli, Paolo ; Frigo, Anna Chiara ; Del Poggio, Paolo ; Rapaccini, Gianludovico ; Di Nolfo, Maria Anna ; Benvegnù, Luisa ; Zoli, Marco ; Borzio, Franco ; Giannini, Edoardo Giovanni ; Caturelli, Eugenio ; Chiaramonte, Maria ; Trevisani, Franco ; Cillo, Umberto. / Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma : A multicentre, cohort study. In: The Lancet Oncology. 2011 ; Vol. 12, No. 7. pp. 654-662.
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title = "Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: A multicentre, cohort study",
abstract = "Background: Allocation of deceased-donor livers to patients with chronic liver failure is improved by prioritising patients by 5-year liver transplantation survival benefit. The Barcelona Clinic Liver Cancer (BCLC) staging has been proposed as the standard means to assess for prognosis of patients with hepatocellular carcinoma. We aimed to create a prediction model linking the BCLC stage of patients with hepatocellular carcinoma to their 5-year liver transplant benefit. Methods: A large cohort of consecutive patients with hepatocellular carcinoma (n=1328) from the ITA.LI.CA database (n=2951) were judged as potentially eligible for liver transplantation according to the following criteria: absence of macroscopic vascular invasion or metastases, age 70 years or younger, and absence of relevant extra-hepatic comorbidities. To assess the correlation between BCLC staging and non-liver transplantation survival, we did Cox univariate and multivariate analyses including the following covariates: BCLC stage, year of diagnosis, age, sex, cause of cirrhosis, model for end-stage liver disease score, α-fetoprotein concentrations, and treatment. Liver-transplantation survival benefit for patients was calculated, using Monte Carlo simulation analysis, as the patient's 5-year life expectancy with liver transplantation (estimated by the Metroticket model) minus the 5-year life expectancy without liver transplantation according to BCLC stage. Findings: 83 (6{\%}) of 1328 patients had BCLC 0 stage disease, 614 (46{\%}) had BCLC A, 500 (38{\%}) had BCLC B-C, and 131 (10{\%}) had BCLC D. In the Cox non-liver transplantation survival multivariate model, hazard ratios associated with increasing BCLC stages were 1·530 (95{\%} CI 1·107-2·116) for BCLC A versus BCLC 0, 1·572 (1·350-1·830) for BCLC B-C versus BCLC A, and 1·470 (1·164-1·856) for BCLC D versus BCLC B-C. Results of the Monte Carlo simulation analysis confirmed the significant effect of BCLC classification on transplant benefit; in the adjusted model, a median 5-year transplant benefit of 11·19 months (IQR 10·73-11·67) for BCLC 0, 13·49 months (11·51-15·57) for BCLC A, 17·36 months (15·06-19·28) for BCLC B-C, and 28·46 months (26·38-30·34) for BCLC D. Interpretation: Liver transplantation could result in survival benefit for patients with hepatocellular carcinoma and advanced liver cirrhosis (BCLC stage D) and in those with intermediate tumours (BCLC stages B-C), regardless of the nodule number-size criteria (ie, Milan criteria), provided that macroscopic vascular invasion and extra-hepatic disease are absent. Funding: None.",
author = "Alessandro Vitale and Morales, {Rafael Ramirez} and Giacomo Zanus and Fabio Farinati and Patrizia Burra and Paolo Angeli and Frigo, {Anna Chiara} and {Del Poggio}, Paolo and Gianludovico Rapaccini and {Di Nolfo}, {Maria Anna} and Luisa Benvegn{\`u} and Marco Zoli and Franco Borzio and Giannini, {Edoardo Giovanni} and Eugenio Caturelli and Maria Chiaramonte and Franco Trevisani and Umberto Cillo",
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TY - JOUR

T1 - Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma

T2 - A multicentre, cohort study

AU - Vitale, Alessandro

AU - Morales, Rafael Ramirez

AU - Zanus, Giacomo

AU - Farinati, Fabio

AU - Burra, Patrizia

AU - Angeli, Paolo

AU - Frigo, Anna Chiara

AU - Del Poggio, Paolo

AU - Rapaccini, Gianludovico

AU - Di Nolfo, Maria Anna

AU - Benvegnù, Luisa

AU - Zoli, Marco

AU - Borzio, Franco

AU - Giannini, Edoardo Giovanni

AU - Caturelli, Eugenio

AU - Chiaramonte, Maria

AU - Trevisani, Franco

AU - Cillo, Umberto

PY - 2011/7

Y1 - 2011/7

N2 - Background: Allocation of deceased-donor livers to patients with chronic liver failure is improved by prioritising patients by 5-year liver transplantation survival benefit. The Barcelona Clinic Liver Cancer (BCLC) staging has been proposed as the standard means to assess for prognosis of patients with hepatocellular carcinoma. We aimed to create a prediction model linking the BCLC stage of patients with hepatocellular carcinoma to their 5-year liver transplant benefit. Methods: A large cohort of consecutive patients with hepatocellular carcinoma (n=1328) from the ITA.LI.CA database (n=2951) were judged as potentially eligible for liver transplantation according to the following criteria: absence of macroscopic vascular invasion or metastases, age 70 years or younger, and absence of relevant extra-hepatic comorbidities. To assess the correlation between BCLC staging and non-liver transplantation survival, we did Cox univariate and multivariate analyses including the following covariates: BCLC stage, year of diagnosis, age, sex, cause of cirrhosis, model for end-stage liver disease score, α-fetoprotein concentrations, and treatment. Liver-transplantation survival benefit for patients was calculated, using Monte Carlo simulation analysis, as the patient's 5-year life expectancy with liver transplantation (estimated by the Metroticket model) minus the 5-year life expectancy without liver transplantation according to BCLC stage. Findings: 83 (6%) of 1328 patients had BCLC 0 stage disease, 614 (46%) had BCLC A, 500 (38%) had BCLC B-C, and 131 (10%) had BCLC D. In the Cox non-liver transplantation survival multivariate model, hazard ratios associated with increasing BCLC stages were 1·530 (95% CI 1·107-2·116) for BCLC A versus BCLC 0, 1·572 (1·350-1·830) for BCLC B-C versus BCLC A, and 1·470 (1·164-1·856) for BCLC D versus BCLC B-C. Results of the Monte Carlo simulation analysis confirmed the significant effect of BCLC classification on transplant benefit; in the adjusted model, a median 5-year transplant benefit of 11·19 months (IQR 10·73-11·67) for BCLC 0, 13·49 months (11·51-15·57) for BCLC A, 17·36 months (15·06-19·28) for BCLC B-C, and 28·46 months (26·38-30·34) for BCLC D. Interpretation: Liver transplantation could result in survival benefit for patients with hepatocellular carcinoma and advanced liver cirrhosis (BCLC stage D) and in those with intermediate tumours (BCLC stages B-C), regardless of the nodule number-size criteria (ie, Milan criteria), provided that macroscopic vascular invasion and extra-hepatic disease are absent. Funding: None.

AB - Background: Allocation of deceased-donor livers to patients with chronic liver failure is improved by prioritising patients by 5-year liver transplantation survival benefit. The Barcelona Clinic Liver Cancer (BCLC) staging has been proposed as the standard means to assess for prognosis of patients with hepatocellular carcinoma. We aimed to create a prediction model linking the BCLC stage of patients with hepatocellular carcinoma to their 5-year liver transplant benefit. Methods: A large cohort of consecutive patients with hepatocellular carcinoma (n=1328) from the ITA.LI.CA database (n=2951) were judged as potentially eligible for liver transplantation according to the following criteria: absence of macroscopic vascular invasion or metastases, age 70 years or younger, and absence of relevant extra-hepatic comorbidities. To assess the correlation between BCLC staging and non-liver transplantation survival, we did Cox univariate and multivariate analyses including the following covariates: BCLC stage, year of diagnosis, age, sex, cause of cirrhosis, model for end-stage liver disease score, α-fetoprotein concentrations, and treatment. Liver-transplantation survival benefit for patients was calculated, using Monte Carlo simulation analysis, as the patient's 5-year life expectancy with liver transplantation (estimated by the Metroticket model) minus the 5-year life expectancy without liver transplantation according to BCLC stage. Findings: 83 (6%) of 1328 patients had BCLC 0 stage disease, 614 (46%) had BCLC A, 500 (38%) had BCLC B-C, and 131 (10%) had BCLC D. In the Cox non-liver transplantation survival multivariate model, hazard ratios associated with increasing BCLC stages were 1·530 (95% CI 1·107-2·116) for BCLC A versus BCLC 0, 1·572 (1·350-1·830) for BCLC B-C versus BCLC A, and 1·470 (1·164-1·856) for BCLC D versus BCLC B-C. Results of the Monte Carlo simulation analysis confirmed the significant effect of BCLC classification on transplant benefit; in the adjusted model, a median 5-year transplant benefit of 11·19 months (IQR 10·73-11·67) for BCLC 0, 13·49 months (11·51-15·57) for BCLC A, 17·36 months (15·06-19·28) for BCLC B-C, and 28·46 months (26·38-30·34) for BCLC D. Interpretation: Liver transplantation could result in survival benefit for patients with hepatocellular carcinoma and advanced liver cirrhosis (BCLC stage D) and in those with intermediate tumours (BCLC stages B-C), regardless of the nodule number-size criteria (ie, Milan criteria), provided that macroscopic vascular invasion and extra-hepatic disease are absent. Funding: None.

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