TY - JOUR
T1 - Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions
T2 - A Multicenter Cohort Study
AU - On behalf of the Italian Liver Cancer (ITA.LI.CA) group
AU - Vitale, Alessandro
AU - Farinati, Fabio
AU - Noaro, Giulia
AU - Burra, Patrizia
AU - Pawlik, Timothy M.
AU - Bucci, Laura
AU - Giannini, Edoardo G.
AU - Faggiano, Chiara
AU - Ciccarese, Francesca
AU - Rapaccini, Gian Lodovico
AU - Di Marco, Maria
AU - Caturelli, Eugenio
AU - Zoli, Marco
AU - Borzio, Franco
AU - Sacco, Rodolfo
AU - Cabibbo, Giuseppe
AU - Virdone, Roberto
AU - Marra, Fabio
AU - Felder, Martina
AU - Morisco, Filomena
AU - Benvegnù, Luisa
AU - Gasbarrini, Antonio
AU - Svegliati-Baroni, Gianluca
AU - Foschi, Francesco Giuseppe
AU - Olivani, Andrea
AU - Masotto, Alberto
AU - Nardone, Gerardo
AU - Colecchia, Antonio
AU - Fornari, Fabio
AU - Marignani, Massimo
AU - Vicari, Susanna
AU - Bortolini, Emanuela
AU - Cozzolongo, Raffaele
AU - Grasso, Alessandro
AU - Aliberti, Camillo
AU - Bernardi, Mauro
AU - Frigo, Anna Chiara
AU - Borzio, Mauro
AU - Trevisani, Franco
AU - Cillo, Umberto
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively). Conclusion: Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.
AB - Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively). Conclusion: Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.
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U2 - 10.1002/hep.30185
DO - 10.1002/hep.30185
M3 - Article
C2 - 30048016
AN - SCOPUS:85054371893
VL - 68
SP - 1232
EP - 1244
JO - Hepatology
JF - Hepatology
SN - 0270-9139
IS - 4
ER -