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

E.G. Giannini, L. Bucci, F. Garuti, M. Brunacci, B. Lenzi, M. Valente, E. Caturelli, G. Cabibbo, F. Piscaglia, R. Virdone, M. Felder, F. Ciccarese, F.G. Foschi, R. Sacco, G. Svegliati Baroni, F. Farinati, G.L. Rapaccini, A. Olivani, A. Gasbarrini, M. Di Marco & 11 others F. Morisco, M. Zoli, A. Masotto, F. Borzio, L. Benvegnù, F. Marra, A. Colecchia, G. Nardone, M. Bernardi, F. Trevisani, for the Italian Liver Cancer (ITA.LI.CA) group

Research output: Contribution to journalArticle

Abstract

The Barcelona Clinic Liver Cancer (BCLC) 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 subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified 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 (AFP) 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, tumor size, MVI, EHS, AFP 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 subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796). © 2017 by the American Association for the Study of Liver Diseases.
Original languageEnglish
Pages (from-to)1784-1796
Number of pages13
JournalHepatology
Volume67
Issue number5
DOIs
Publication statusPublished - 2018

Fingerprint

Hepatocellular Carcinoma
Liver Neoplasms
alpha-Fetoproteins
Survival
Therapeutics
End Stage Liver Disease
Gastroenterology
Platelet Count
Ascites
Albumins
Neoplasms
Databases

Keywords

  • albumin
  • alpha fetoprotein
  • sorafenib
  • alpha fetoprotein, adult
  • advanced cancer
  • aged
  • albumin blood level
  • alpha fetoprotein blood level
  • Article
  • ascites
  • cancer chemotherapy
  • cancer diagnosis
  • cancer patient
  • cancer prognosis
  • cancer survival
  • cause of death
  • chemoembolization
  • Child Pugh score
  • clinical feature
  • clinical practice
  • computer assisted tomography
  • female
  • histology
  • human
  • liver cell carcinoma
  • liver graft
  • liver metastasis
  • liver resection
  • major clinical study
  • male
  • Model For End Stage Liver Disease Score
  • nuclear magnetic resonance imaging
  • overall survival
  • personalized medicine
  • platelet count
  • priority journal
  • radioembolization
  • tumor invasion
  • tumor volume
  • cancer staging
  • factual database
  • liver
  • liver tumor
  • metabolism
  • middle aged
  • mortality
  • pathology
  • procedures
  • prognosis
  • retrospective study
  • survival analysis
  • treatment outcome
  • very elderly, Aged
  • Aged, 80 and over
  • alpha-Fetoproteins
  • Carcinoma, Hepatocellular
  • Databases, Factual
  • Female
  • Humans
  • Liver
  • Liver Neoplasms
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Precision Medicine
  • Prognosis
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome

Cite this

Giannini, E. G., Bucci, L., Garuti, F., Brunacci, M., Lenzi, B., Valente, M., ... group, F. T. I. L. C. ITA. LI. CA. (2018). Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice. Hepatology, 67(5), 1784-1796. https://doi.org/10.1002/hep.29668

Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice. / 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.; Svegliati Baroni, G.; Farinati, F.; Rapaccini, G.L.; Olivani, A.; Gasbarrini, A.; Di Marco, M.; Morisco, F.; Zoli, M.; Masotto, A.; Borzio, F.; Benvegnù, L.; Marra, F.; Colecchia, A.; Nardone, G.; Bernardi, M.; Trevisani, F.; group, for the Italian Liver Cancer (ITA.LI.CA).

In: Hepatology, Vol. 67, No. 5, 2018, p. 1784-1796.

Research output: Contribution to journalArticle

Giannini, EG, Bucci, L, Garuti, F, Brunacci, M, Lenzi, B, Valente, M, Caturelli, E, Cabibbo, G, Piscaglia, F, Virdone, R, Felder, M, Ciccarese, F, Foschi, FG, Sacco, R, Svegliati Baroni, G, Farinati, F, Rapaccini, GL, Olivani, A, Gasbarrini, A, Di Marco, M, Morisco, F, Zoli, M, Masotto, A, Borzio, F, Benvegnù, L, Marra, F, Colecchia, A, Nardone, G, Bernardi, M, Trevisani, F & group, FTILCITALICA 2018, 'Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice', Hepatology, vol. 67, no. 5, pp. 1784-1796. https://doi.org/10.1002/hep.29668
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. ; Svegliati Baroni, G. ; Farinati, F. ; Rapaccini, G.L. ; Olivani, A. ; Gasbarrini, A. ; Di Marco, M. ; Morisco, F. ; Zoli, M. ; Masotto, A. ; Borzio, F. ; Benvegnù, L. ; Marra, F. ; Colecchia, A. ; Nardone, G. ; Bernardi, M. ; Trevisani, F. ; group, for the Italian Liver Cancer (ITA.LI.CA). / Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice. In: Hepatology. 2018 ; Vol. 67, No. 5. pp. 1784-1796.
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abstract = "The Barcelona Clinic Liver Cancer (BCLC) 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 subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified 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 (AFP) 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, tumor size, MVI, EHS, AFP 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 subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796). {\circledC} 2017 by the American Association for the Study of Liver Diseases.",
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T1 - Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice

AU - Giannini, E.G.

AU - Bucci, L.

AU - Garuti, F.

AU - Brunacci, M.

AU - Lenzi, B.

AU - Valente, M.

AU - Caturelli, E.

AU - Cabibbo, G.

AU - Piscaglia, F.

AU - Virdone, R.

AU - Felder, M.

AU - Ciccarese, F.

AU - Foschi, F.G.

AU - Sacco, R.

AU - Svegliati Baroni, G.

AU - Farinati, F.

AU - Rapaccini, G.L.

AU - Olivani, A.

AU - Gasbarrini, A.

AU - Di Marco, M.

AU - Morisco, F.

AU - Zoli, M.

AU - Masotto, A.

AU - Borzio, F.

AU - Benvegnù, L.

AU - Marra, F.

AU - Colecchia, A.

AU - Nardone, G.

AU - Bernardi, M.

AU - Trevisani, F.

AU - group, for the Italian Liver Cancer (ITA.LI.CA)

N1 - cited By 9

PY - 2018

Y1 - 2018

N2 - The Barcelona Clinic Liver Cancer (BCLC) 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 subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified 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 (AFP) 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, tumor size, MVI, EHS, AFP 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 subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796). © 2017 by the American Association for the Study of Liver Diseases.

AB - The Barcelona Clinic Liver Cancer (BCLC) 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 subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified 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 (AFP) 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, tumor size, MVI, EHS, AFP 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 subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796). © 2017 by the American Association for the Study of Liver Diseases.

KW - albumin

KW - alpha fetoprotein

KW - sorafenib

KW - alpha fetoprotein, adult

KW - advanced cancer

KW - aged

KW - albumin blood level

KW - alpha fetoprotein blood level

KW - Article

KW - ascites

KW - cancer chemotherapy

KW - cancer diagnosis

KW - cancer patient

KW - cancer prognosis

KW - cancer survival

KW - cause of death

KW - chemoembolization

KW - Child Pugh score

KW - clinical feature

KW - clinical practice

KW - computer assisted tomography

KW - female

KW - histology

KW - human

KW - liver cell carcinoma

KW - liver graft

KW - liver metastasis

KW - liver resection

KW - major clinical study

KW - male

KW - Model For End Stage Liver Disease Score

KW - nuclear magnetic resonance imaging

KW - overall survival

KW - personalized medicine

KW - platelet count

KW - priority journal

KW - radioembolization

KW - tumor invasion

KW - tumor volume

KW - cancer staging

KW - factual database

KW - liver

KW - liver tumor

KW - metabolism

KW - middle aged

KW - mortality

KW - pathology

KW - procedures

KW - prognosis

KW - retrospective study

KW - survival analysis

KW - treatment outcome

KW - very elderly, Aged

KW - Aged, 80 and over

KW - alpha-Fetoproteins

KW - Carcinoma, Hepatocellular

KW - Databases, Factual

KW - Female

KW - Humans

KW - Liver

KW - Liver Neoplasms

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Precision Medicine

KW - Prognosis

KW - Retrospective Studies

KW - Survival Analysis

KW - Treatment Outcome

U2 - 10.1002/hep.29668

DO - 10.1002/hep.29668

M3 - Article

VL - 67

SP - 1784

EP - 1796

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 5

ER -