Multimodality treatment of hepatocellular carcinoma

How field practice complies with international recommendations

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. Aim: We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). Methods: 370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. Results: Treatment was adherent to AASLD recommendations in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0% vs 10.4% P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6% vs 20.7%, P = .029) and BCLC C (42.6% vs 59.0%, P = .04) patients. Conclusions: HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.

Original languageEnglish
Pages (from-to)1624-1634
JournalLiver International
Volume38
Issue number9
DOIs
Publication statusPublished - 2018

Fingerprint

Hepatocellular Carcinoma
Therapeutics
Mortality
Standard of Care
Guidelines
Survival
Liver

Keywords

  • BCLC stage
  • Cirrhosis
  • HCC treatment
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{f723956072b840f7b8e7a02c278d2f15,
title = "Multimodality treatment of hepatocellular carcinoma: How field practice complies with international recommendations",
abstract = "Background: Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. Aim: We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). Methods: 370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. Results: Treatment was adherent to AASLD recommendations in 205 (81{\%}) BCLC A patients, 36 (54{\%}) BCLC B, and 27 (53{\%}) BCLC C. Radiological complete response was achieved in 165 (45{\%}) patients after the first-line treatment, in 22 (19{\%}) after a second-line and in 9 (23{\%}) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0{\%} vs 10.4{\%} P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6{\%} vs 20.7{\%}, P = .029) and BCLC C (42.6{\%} vs 59.0{\%}, P = .04) patients. Conclusions: HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.",
keywords = "BCLC stage, Cirrhosis, HCC treatment, Hepatocellular carcinoma",
author = "Angelo Sangiovanni and Michela Triolo and Massimo Iavarone and Forzenigo, {Laura V.} and Antonio Nicolini and Giorgio Rossi and {La Mura}, Vincenzo and Massimo Colombo and Pietro Lampertico",
year = "2018",
doi = "10.1111/liv.13888",
language = "English",
volume = "38",
pages = "1624--1634",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "9",

}

TY - JOUR

T1 - Multimodality treatment of hepatocellular carcinoma

T2 - How field practice complies with international recommendations

AU - Sangiovanni, Angelo

AU - Triolo, Michela

AU - Iavarone, Massimo

AU - Forzenigo, Laura V.

AU - Nicolini, Antonio

AU - Rossi, Giorgio

AU - La Mura, Vincenzo

AU - Colombo, Massimo

AU - Lampertico, Pietro

PY - 2018

Y1 - 2018

N2 - Background: Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. Aim: We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). Methods: 370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. Results: Treatment was adherent to AASLD recommendations in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0% vs 10.4% P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6% vs 20.7%, P = .029) and BCLC C (42.6% vs 59.0%, P = .04) patients. Conclusions: HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.

AB - Background: Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. Aim: We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). Methods: 370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. Results: Treatment was adherent to AASLD recommendations in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0% vs 10.4% P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6% vs 20.7%, P = .029) and BCLC C (42.6% vs 59.0%, P = .04) patients. Conclusions: HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.

KW - BCLC stage

KW - Cirrhosis

KW - HCC treatment

KW - Hepatocellular carcinoma

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U2 - 10.1111/liv.13888

DO - 10.1111/liv.13888

M3 - Article

VL - 38

SP - 1624

EP - 1634

JO - Liver International

JF - Liver International

SN - 1478-3223

IS - 9

ER -