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

Edoardo G Giannini, Laura Bucci, Francesca Garuti, Matteo Brunacci, Barbara 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 MarcoFilomena Morisco, Marco Zoli, Alberto Masotto, Franco Borzio, Luisa Benvegnù, Fabio Marra, Antonio Colecchia, Gerardo Nardone, Mauro Bernardi, Franco Trevisani, Italian Liver Cancer (ITA.LI.CA) group

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Abstract

The Barcelona Clinic Liver Cancer 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 sub-classified according to clinical features (Performance Status [PS], macro-vascular invasion [MVI], extra-hepatic spread [EHS] or MVI+EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analysed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were sub-classified 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 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, tumour size, MVI, EHS, alpha-fetoprotein 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 sub-classified according to PS and tumour features, and new patient-tailored therapeutic indications are needed. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalHepatology
DOIs
Publication statusE-pub ahead of print - Nov 21 2017

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  • Journal Article

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    Giannini, E. G., Bucci, L., Garuti, F., Brunacci, M., Lenzi, B., Valente, M., Caturelli, E., Cabibbo, G., Piscaglia, F., Virdone, R., Felder, M., Ciccarese, F., Foschi, F. G., Sacco, R., Baroni, G. S., Farinati, F., Rapaccini, G. L., Olivani, A., Gasbarrini, A., ... Italian Liver Cancer (ITA.LI.CA) group (2017). Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice. Hepatology. https://doi.org/10.1002/hep.29668