BCLC stage B hepatocellular carcinoma and transcatheter arterial chemoembolization: A 20-year survey by the Italian Liver Cancer group

Fabio Farinati, Veronica Vanin, Anna Giacomin, Caterina Pozzan, Umberto Cillo, Alessandro Vitale, Anna Maria Di Nolfo, Paolo Del Poggio, Luisa Benvegnu', Gianludovico Rapaccini, Marco Zoli, Franco Borzio, Edoardo G. Giannini, Eugenio Caturelli, Franco Trevisani, Mauro Bernardi, Maurizio Biselli, Romina Cassini, Paolo Caraceni, Marco DomenicaliVirginia Erroi, Marta Frigerio, Annagiulia Gramenzi, Barbara Lenzi, Donatella Magalotti, Claudia Balsamo, Maria Di Marco, Elena Vavassori, Lodovico Gilardoni, Mario Mattiello, Alfredo Alberti, Anna Giacomin, Gemma Maddalo, Francesca Murer, Alessia Gazzola, Matteo Ravaioli, Alessandro Cucchetti, Emanuela Giampalma, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Giorgia Ghittoni, Paola Roselli, Giulia Bosco

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Significant proportion of Hepatocellular Carcinoma (HCC) cases are diagnosed in stage B of Barcelona Clinic Liver Cancer (BCLC) algorithm, in which the standard of care is Transcatheter Arterial ChemoEmbolization (TACE). We aimed to ascertain adherence to current guidelines, survival and prognostic factors in BCLC stage B patients. Methods: From 3027 HCC cases recruited from 1986 to 2008 by the Italian Liver Cancer group (2430 with data allowing a correct allocation in the BCLC system), a retrospective analysis was conducted on those diagnosed in BCLC stage B (405 patients, 17%). Statistics were performed with Kaplan-Meier (log rank) method and Cox multivariate analysis. Results: Median overall survival in BCLC stage B patients was 25 months (Confidence Interval - C.I. - 22-28 months) with a 5-year survival of 18%. Child-Pugh class, oesophageal varices and Alpha-foetoprotein (AFP) were the independent predictors of survival. TACE was applied in 40% of cases and did not offer the longest survival in comparison with surgical or percutaneous treatments (median 27 months vs. 37 and 36 months, respectively) (P <0.001). BCLC stage B patients undergoing radical treatments were more frequently in Child-Pugh class A and had a significantly lower number of lesions; patients undergoing best supportive care were frequently in Child-Pugh class B and had a multifocal disease. Survival after TACE did not significantly increase over time. Conclusions: In clinical practice, TACE cannot be considered the best approach for BCLC stage B patients who represent a heterogeneous population and are often suitable for more aggressive therapies, which lead to a better survival.

Original languageEnglish
Pages (from-to)223-231
Number of pages9
JournalLiver International
Volume35
Issue number1
DOIs
Publication statusPublished - Jan 1 2015

Keywords

  • BCLC algorithm
  • Hepatocellular carcinoma
  • Transcatheter arterial chemoembolization
  • Treatment choice

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

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