Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

Anna Pecorelli, Barbara Lenzi, Annagiulia Gramenzi, Francesca Garuti, Fabio Farinati, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Gian Lodovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Rodolfo Sacco, Giuseppe Cabibbo, Martina Felder, Filomena Morisco, Antonio Gasbarrini, Gianluca Svegliati Baroni, Francesco G. FoschiElisabetta Biasini, Alberto Masotto, Roberto Virdone, Mauro Bernardi, Franco Trevisani

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background & Aims: The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. Methods: Retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naïve HCC after 1999. Patients were stratified by treatment. Results: 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (P<.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality (HR 0.197, 95%CI: 0.098-0.395) more than TACE (HR 0.408, 95%CI: 0.211-0.789) (P<.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. Conclusions: In everyday practice TACE represents the first-line therapy in an half of patients with naïve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-B patients and curative options offer the best outcome.

Original languageEnglish
JournalLiver International
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Standard of Care
Hepatocellular Carcinoma
Therapeutics
Propensity Score
Liver
Lost to Follow-Up
Liver Neoplasms
Tumor Burden
Comorbidity

Keywords

  • HCC
  • BCLC-B
  • Intermediate stage
  • Treatment

ASJC Scopus subject areas

  • Hepatology

Cite this

Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma. / Pecorelli, Anna; Lenzi, Barbara; Gramenzi, Annagiulia; Garuti, Francesca; Farinati, Fabio; Giannini, Edoardo G.; Ciccarese, Francesca; Piscaglia, Fabio; Rapaccini, Gian Lodovico; Di Marco, Maria; Caturelli, Eugenio; Zoli, Marco; Borzio, Franco; Sacco, Rodolfo; Cabibbo, Giuseppe; Felder, Martina; Morisco, Filomena; Gasbarrini, Antonio; Baroni, Gianluca Svegliati; Foschi, Francesco G.; Biasini, Elisabetta; Masotto, Alberto; Virdone, Roberto; Bernardi, Mauro; Trevisani, Franco.

In: Liver International, 2016.

Research output: Contribution to journalArticle

Pecorelli, A, Lenzi, B, Gramenzi, A, Garuti, F, Farinati, F, Giannini, EG, Ciccarese, F, Piscaglia, F, Rapaccini, GL, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Cabibbo, G, Felder, M, Morisco, F, Gasbarrini, A, Baroni, GS, Foschi, FG, Biasini, E, Masotto, A, Virdone, R, Bernardi, M & Trevisani, F 2016, 'Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma', Liver International. https://doi.org/10.1111/liv.13242
Pecorelli, Anna ; Lenzi, Barbara ; Gramenzi, Annagiulia ; Garuti, Francesca ; Farinati, Fabio ; Giannini, Edoardo G. ; Ciccarese, Francesca ; Piscaglia, Fabio ; Rapaccini, Gian Lodovico ; Di Marco, Maria ; Caturelli, Eugenio ; Zoli, Marco ; Borzio, Franco ; Sacco, Rodolfo ; Cabibbo, Giuseppe ; Felder, Martina ; Morisco, Filomena ; Gasbarrini, Antonio ; Baroni, Gianluca Svegliati ; Foschi, Francesco G. ; Biasini, Elisabetta ; Masotto, Alberto ; Virdone, Roberto ; Bernardi, Mauro ; Trevisani, Franco. / Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma. In: Liver International. 2016.
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title = "Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma",
abstract = "Background & Aims: The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. Methods: Retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with na{\"i}ve HCC after 1999. Patients were stratified by treatment. Results: 29 patients (6{\%}) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1{\%}), curative treatments (145 patients, 31.8{\%}), sorafenib (18, 3.9{\%}), other (39, 8.5{\%}), best supportive care (BSC) (21, 4.6{\%}). Median survival (95{\%} CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (P<.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality (HR 0.197, 95{\%}CI: 0.098-0.395) more than TACE (HR 0.408, 95{\%}CI: 0.211-0.789) (P<.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. Conclusions: In everyday practice TACE represents the first-line therapy in an half of patients with na{\"i}ve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-B patients and curative options offer the best outcome.",
keywords = "HCC, BCLC-B, Intermediate stage, Treatment",
author = "Anna Pecorelli and Barbara Lenzi and Annagiulia Gramenzi and Francesca Garuti and Fabio Farinati and Giannini, {Edoardo G.} and Francesca Ciccarese and Fabio Piscaglia and Rapaccini, {Gian Lodovico} and {Di Marco}, Maria and Eugenio Caturelli and Marco Zoli and Franco Borzio and Rodolfo Sacco and Giuseppe Cabibbo and Martina Felder and Filomena Morisco and Antonio Gasbarrini and Baroni, {Gianluca Svegliati} and Foschi, {Francesco G.} and Elisabetta Biasini and Alberto Masotto and Roberto Virdone and Mauro Bernardi and Franco Trevisani",
year = "2016",
doi = "10.1111/liv.13242",
language = "English",
journal = "Liver International",
issn = "1478-3223",
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TY - JOUR

T1 - Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

AU - Pecorelli, Anna

AU - Lenzi, Barbara

AU - Gramenzi, Annagiulia

AU - Garuti, Francesca

AU - Farinati, Fabio

AU - Giannini, Edoardo G.

AU - Ciccarese, Francesca

AU - Piscaglia, Fabio

AU - Rapaccini, Gian Lodovico

AU - Di Marco, Maria

AU - Caturelli, Eugenio

AU - Zoli, Marco

AU - Borzio, Franco

AU - Sacco, Rodolfo

AU - Cabibbo, Giuseppe

AU - Felder, Martina

AU - Morisco, Filomena

AU - Gasbarrini, Antonio

AU - Baroni, Gianluca Svegliati

AU - Foschi, Francesco G.

AU - Biasini, Elisabetta

AU - Masotto, Alberto

AU - Virdone, Roberto

AU - Bernardi, Mauro

AU - Trevisani, Franco

PY - 2016

Y1 - 2016

N2 - Background & Aims: The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. Methods: Retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naïve HCC after 1999. Patients were stratified by treatment. Results: 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (P<.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality (HR 0.197, 95%CI: 0.098-0.395) more than TACE (HR 0.408, 95%CI: 0.211-0.789) (P<.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. Conclusions: In everyday practice TACE represents the first-line therapy in an half of patients with naïve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-B patients and curative options offer the best outcome.

AB - Background & Aims: The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. Methods: Retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naïve HCC after 1999. Patients were stratified by treatment. Results: 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (P<.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality (HR 0.197, 95%CI: 0.098-0.395) more than TACE (HR 0.408, 95%CI: 0.211-0.789) (P<.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. Conclusions: In everyday practice TACE represents the first-line therapy in an half of patients with naïve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-B patients and curative options offer the best outcome.

KW - HCC

KW - BCLC-B

KW - Intermediate stage

KW - Treatment

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U2 - 10.1111/liv.13242

DO - 10.1111/liv.13242

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AN - SCOPUS:84990177114

JO - Liver International

JF - Liver International

SN - 1478-3223

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