Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study

A. Vitale, F. Farinati, G. Noaro, P. Burra, T.M. Pawlik, L. Bucci, E.G. Giannini, C. Faggiano, F. Ciccarese, G.L. Rapaccini, M. Di Marco, E. Caturelli, M. Zoli, F. Borzio, R. Sacco, G. Cabibbo, R. Virdone, F. Marra, M. Felder, F. MoriscoL. Benvegnù, A. Gasbarrini, G. Svegliati-Baroni, F.G. Foschi, A. Olivani, A. Masotto, G. Nardone, A. Colecchia, F. Fornari, M. Marignani, S. Vicari, E. Bortolini, R. Cozzolongo, A. Grasso, C. Aliberti, M. Bernardi, A.C. Frigo, M. Borzio, F. Trevisani, U. Cillo, on behalf of the Italian Liver Cancer (ITA.LI.CA) group

Research output: Contribution to journalArticle

Abstract

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. © 2018 by the American Association for the Study of Liver Diseases.
Original languageEnglish
Pages (from-to)1232-1244
Number of pages13
JournalHepatology
Volume68
Issue number4
DOIs
Publication statusPublished - 2018

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Multicenter Studies
Hepatocellular Carcinoma
Cohort Studies
Liver Neoplasms
Therapeutics
End Stage Liver Disease
Hong Kong
Survival Analysis
Disease Progression
Databases

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Vitale, A., Farinati, F., Noaro, G., Burra, P., Pawlik, T. M., Bucci, L., ... group, O. B. O. T. I. L. C. ITA. LI. CA. (2018). Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study. Hepatology, 68(4), 1232-1244. https://doi.org/10.1002/hep.30185

Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study. / Vitale, A.; Farinati, F.; Noaro, G.; Burra, P.; Pawlik, T.M.; Bucci, L.; Giannini, E.G.; Faggiano, C.; Ciccarese, F.; Rapaccini, G.L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Sacco, R.; Cabibbo, G.; Virdone, R.; Marra, F.; Felder, M.; Morisco, F.; Benvegnù, L.; Gasbarrini, A.; Svegliati-Baroni, G.; Foschi, F.G.; Olivani, A.; Masotto, A.; Nardone, G.; Colecchia, A.; Fornari, F.; Marignani, M.; Vicari, S.; Bortolini, E.; Cozzolongo, R.; Grasso, A.; Aliberti, C.; Bernardi, M.; Frigo, A.C.; Borzio, M.; Trevisani, F.; Cillo, U.; group, on behalf of the Italian Liver Cancer (ITA.LI.CA).

In: Hepatology, Vol. 68, No. 4, 2018, p. 1232-1244.

Research output: Contribution to journalArticle

Vitale, A, Farinati, F, Noaro, G, Burra, P, Pawlik, TM, Bucci, L, Giannini, EG, Faggiano, C, Ciccarese, F, Rapaccini, GL, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Cabibbo, G, Virdone, R, Marra, F, Felder, M, Morisco, F, Benvegnù, L, Gasbarrini, A, Svegliati-Baroni, G, Foschi, FG, Olivani, A, Masotto, A, Nardone, G, Colecchia, A, Fornari, F, Marignani, M, Vicari, S, Bortolini, E, Cozzolongo, R, Grasso, A, Aliberti, C, Bernardi, M, Frigo, AC, Borzio, M, Trevisani, F, Cillo, U & group, OBOTILCITALICA 2018, 'Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study', Hepatology, vol. 68, no. 4, pp. 1232-1244. https://doi.org/10.1002/hep.30185
Vitale, A. ; Farinati, F. ; Noaro, G. ; Burra, P. ; Pawlik, T.M. ; Bucci, L. ; Giannini, E.G. ; Faggiano, C. ; Ciccarese, F. ; Rapaccini, G.L. ; Di Marco, M. ; Caturelli, E. ; Zoli, M. ; Borzio, F. ; Sacco, R. ; Cabibbo, G. ; Virdone, R. ; Marra, F. ; Felder, M. ; Morisco, F. ; Benvegnù, L. ; Gasbarrini, A. ; Svegliati-Baroni, G. ; Foschi, F.G. ; Olivani, A. ; Masotto, A. ; Nardone, G. ; Colecchia, A. ; Fornari, F. ; Marignani, M. ; Vicari, S. ; Bortolini, E. ; Cozzolongo, R. ; Grasso, A. ; Aliberti, C. ; Bernardi, M. ; Frigo, A.C. ; Borzio, M. ; Trevisani, F. ; Cillo, U. ; group, on behalf of the Italian Liver Cancer (ITA.LI.CA). / Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study. In: Hepatology. 2018 ; Vol. 68, No. 4. pp. 1232-1244.
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title = "Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study",
abstract = "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. {\circledC} 2018 by the American Association for the Study of Liver Diseases.",
author = "A. Vitale and F. Farinati and G. Noaro and P. Burra and T.M. Pawlik and L. Bucci and E.G. Giannini and C. Faggiano and F. Ciccarese and G.L. Rapaccini and {Di Marco}, M. and E. Caturelli and M. Zoli and F. Borzio and R. Sacco and G. Cabibbo and R. Virdone and F. Marra and M. Felder and F. Morisco and L. Benvegn{\`u} and A. Gasbarrini and G. Svegliati-Baroni and F.G. Foschi and A. Olivani and A. Masotto and G. Nardone and A. Colecchia and F. Fornari and M. Marignani and S. Vicari and E. Bortolini and R. Cozzolongo and A. Grasso and C. Aliberti and M. Bernardi and A.C. Frigo and M. Borzio and F. Trevisani and U. Cillo and group, {on behalf of the Italian Liver Cancer (ITA.LI.CA)}",
note = "Cited By :2 Export Date: 25 January 2019 CODEN: HPTLD References: Bruix, J., Sherman, M., Llovet, J.M., Beaugrand, M., Lencioni, R., Burroughs, A.K., Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver (2001) J Hepatol, 35, pp. 421-430; Bruix, J., Sherman, M., Management of hepatocellular carcinoma (2005) Hepatology, 42, pp. 1208-1236; EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma (2012) J Hepatol, 56, pp. 908-943; Liu, P.H., Hsu, C.Y., Hsia, C.Y., Lee, Y.H., Su, C.W., Huang, Y.H., Prognosis of hepatocellular carcinoma: assessment of eleven staging systems (2016) J Hepatol, 64, pp. 601-608; Yau, T., Tang, V.Y., Yao, T.J., Fan, S.T., Lo, C.M., Poon, R.T., Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma (2014) Gastroenterology, 146, pp. 1691-1700; Farinati, F., Vitale, A., Spolverato, G., Pawlik, T.M., Huo, T.L., Lee, Y.H., Development and validation of a new prognostic system for patients with hepatocellular carcinoma (2016) PLoS Med, 13; Borzio, M., Dionigi, E., Rossini, A., Marignani, M., Sacco, R., De Sio, I., External validation of the ITA.LI.CA prognostic system for patients with hepatocellular carcinoma: a multicenter cohort study (2018) Hepatology, 67, pp. 2215-2225; Lencioni, R., Llovet, J.M., Modified RECIST (MRECIST) assessment for hepatocellular carcinoma (2010) Semin Liver Dis, 30, pp. 52-60; Yamashita, Y., Shirabe, K., Tsuijita, E., Takeishi, K., Ikegami, T., Yoshizumi, T., Third or more repeat hepatectomy for recurrent hepatocellular carcinoma (2013) Surgery, 154, pp. 1038-1045; Chan, D.L., Morris, D.L., Chua, T.C., Clinical efficacy and predictors of outcomes of repeat hepatectomy for recurrent hepatocellular carcinoma - a systematic review (2013) Surg Oncol, 22, pp. e23-e30; Child, C.G., Turcotte, J.G., Surgery and portal hypertension (1964) Major Probl Clin Surg, 1, pp. 1-85; Pugh, R.N., Murray-Lyon, I.M., Dawson, J.L., Pietroni, M.C., Williams, R., Transection of the oesophagus for bleeding oesophageal varices (1973) Br J Surg, 60, pp. 646-649; Johnson, P.J., Berhane, S., Kagebayashi, C., Satomura, S., Teng, M., Reeves, H.L., Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—The ALBI grade (2015) J Clin Oncol, 33, pp. 550-558; Bruix, J., Reig, M., Sherman, M., Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma (2016) Gastroenterology, 150, pp. 835-853; Baraldi, A.N., Enders, C.K., An introduction to modern missing data analyses (2010) J Sch Psychol, 48, pp. 5-37; Steyerberg, E.W., Vickers, A.J., Cook, N.R., Gerds, T., Gonen, M., Obuchowski, N., Assessing the performance of prediction models: a framework for traditional and novel measures (2010) Epidemiology, 21, pp. 128-138; Armitage, P., Colton, T., Akaike’s criteria (1998) Encyclopedia of Biostatistics, pp. 123-124. , eds., Chichester, England, Wiley; Yao, F.Y., Mehta, N., Flemming, J., Dodge, J., Hameed, B., Fix, O., Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria (2015) Hepatology, 61, pp. 1968-1977; Ravaioli, M., Grazi, G.L., Piscaglia, F., Trevisani, F., Cescon, M., Ercolani, G., Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria (2008) Am J Transplant, 8, pp. 2547-2557; Cabibbo, G., Petta, S., Barbara, M., Attardo, S., Bucci, L., Farinati, F., Italian Liver Cancer (ITA.LI.CA) group. Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma (2017) J Hepatol, 67, pp. 65-71; Shim, J.H., Lee, H.C., Kim, S.O., Shin, Y.M., Kim, K.M., Lim, Y.S., Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models (2012) Radiology, 262, pp. 708-718; Shuster, A., Huynh, T.J., Rajan, D.K., Marquez, M.A., Grant, D.R., Huynh, D.C., Response Evaluation Criteria in Solid Tumors (RECIST) criteria are superior to European Association for Study of the Liver (EASL) criteria at 1 month follow-up for predicting long-term survival in patients treated with transarterial chemoembolization before liver transplantation for hepatocellular cancer (2013) J Vasc Interv Radiol, 24, pp. 805-812; Tabrizian, P., Jibara, G., Shrager, B., Schwartz, M., Roayaie, S., Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis (2015) Ann Surg, 261, pp. 947-955; Erridge, S., Pucher, P.H., Markar, S.R., Malietzis, G., Athanasiou, T., Darzi, A., Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma (2017) Br J Surg, 104, pp. 1433-1442; Serper, M., Taddei, T.H., Mehta, R., D’Addeo, K., Dai, F., Aytaman, A., Association of provider specialty and multidisciplinary care with hepatocellular carcinoma treatment and mortality (2017) Gastroenterology, 152, pp. 1954-1964",
year = "2018",
doi = "10.1002/hep.30185",
language = "English",
volume = "68",
pages = "1232--1244",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

TY - JOUR

T1 - Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study

AU - Vitale, A.

AU - Farinati, F.

AU - Noaro, G.

AU - Burra, P.

AU - Pawlik, T.M.

AU - Bucci, L.

AU - Giannini, E.G.

AU - Faggiano, C.

AU - Ciccarese, F.

AU - Rapaccini, G.L.

AU - Di Marco, M.

AU - Caturelli, E.

AU - Zoli, M.

AU - Borzio, F.

AU - Sacco, R.

AU - Cabibbo, G.

AU - Virdone, R.

AU - Marra, F.

AU - Felder, M.

AU - Morisco, F.

AU - Benvegnù, L.

AU - Gasbarrini, A.

AU - Svegliati-Baroni, G.

AU - Foschi, F.G.

AU - Olivani, A.

AU - Masotto, A.

AU - Nardone, G.

AU - Colecchia, A.

AU - Fornari, F.

AU - Marignani, M.

AU - Vicari, S.

AU - Bortolini, E.

AU - Cozzolongo, R.

AU - Grasso, A.

AU - Aliberti, C.

AU - Bernardi, M.

AU - Frigo, A.C.

AU - Borzio, M.

AU - Trevisani, F.

AU - Cillo, U.

AU - group, on behalf of the Italian Liver Cancer (ITA.LI.CA)

N1 - Cited By :2 Export Date: 25 January 2019 CODEN: HPTLD References: Bruix, J., Sherman, M., Llovet, J.M., Beaugrand, M., Lencioni, R., Burroughs, A.K., Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver (2001) J Hepatol, 35, pp. 421-430; Bruix, J., Sherman, M., Management of hepatocellular carcinoma (2005) Hepatology, 42, pp. 1208-1236; EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma (2012) J Hepatol, 56, pp. 908-943; Liu, P.H., Hsu, C.Y., Hsia, C.Y., Lee, Y.H., Su, C.W., Huang, Y.H., Prognosis of hepatocellular carcinoma: assessment of eleven staging systems (2016) J Hepatol, 64, pp. 601-608; Yau, T., Tang, V.Y., Yao, T.J., Fan, S.T., Lo, C.M., Poon, R.T., Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma (2014) Gastroenterology, 146, pp. 1691-1700; Farinati, F., Vitale, A., Spolverato, G., Pawlik, T.M., Huo, T.L., Lee, Y.H., Development and validation of a new prognostic system for patients with hepatocellular carcinoma (2016) PLoS Med, 13; Borzio, M., Dionigi, E., Rossini, A., Marignani, M., Sacco, R., De Sio, I., External validation of the ITA.LI.CA prognostic system for patients with hepatocellular carcinoma: a multicenter cohort study (2018) Hepatology, 67, pp. 2215-2225; Lencioni, R., Llovet, J.M., Modified RECIST (MRECIST) assessment for hepatocellular carcinoma (2010) Semin Liver Dis, 30, pp. 52-60; Yamashita, Y., Shirabe, K., Tsuijita, E., Takeishi, K., Ikegami, T., Yoshizumi, T., Third or more repeat hepatectomy for recurrent hepatocellular carcinoma (2013) Surgery, 154, pp. 1038-1045; Chan, D.L., Morris, D.L., Chua, T.C., Clinical efficacy and predictors of outcomes of repeat hepatectomy for recurrent hepatocellular carcinoma - a systematic review (2013) Surg Oncol, 22, pp. e23-e30; Child, C.G., Turcotte, J.G., Surgery and portal hypertension (1964) Major Probl Clin Surg, 1, pp. 1-85; Pugh, R.N., Murray-Lyon, I.M., Dawson, J.L., Pietroni, M.C., Williams, R., Transection of the oesophagus for bleeding oesophageal varices (1973) Br J Surg, 60, pp. 646-649; Johnson, P.J., Berhane, S., Kagebayashi, C., Satomura, S., Teng, M., Reeves, H.L., Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—The ALBI grade (2015) J Clin Oncol, 33, pp. 550-558; Bruix, J., Reig, M., Sherman, M., Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma (2016) Gastroenterology, 150, pp. 835-853; Baraldi, A.N., Enders, C.K., An introduction to modern missing data analyses (2010) J Sch Psychol, 48, pp. 5-37; Steyerberg, E.W., Vickers, A.J., Cook, N.R., Gerds, T., Gonen, M., Obuchowski, N., Assessing the performance of prediction models: a framework for traditional and novel measures (2010) Epidemiology, 21, pp. 128-138; Armitage, P., Colton, T., Akaike’s criteria (1998) Encyclopedia of Biostatistics, pp. 123-124. , eds., Chichester, England, Wiley; Yao, F.Y., Mehta, N., Flemming, J., Dodge, J., Hameed, B., Fix, O., Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria (2015) Hepatology, 61, pp. 1968-1977; Ravaioli, M., Grazi, G.L., Piscaglia, F., Trevisani, F., Cescon, M., Ercolani, G., Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria (2008) Am J Transplant, 8, pp. 2547-2557; Cabibbo, G., Petta, S., Barbara, M., Attardo, S., Bucci, L., Farinati, F., Italian Liver Cancer (ITA.LI.CA) group. Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma (2017) J Hepatol, 67, pp. 65-71; Shim, J.H., Lee, H.C., Kim, S.O., Shin, Y.M., Kim, K.M., Lim, Y.S., Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models (2012) Radiology, 262, pp. 708-718; Shuster, A., Huynh, T.J., Rajan, D.K., Marquez, M.A., Grant, D.R., Huynh, D.C., Response Evaluation Criteria in Solid Tumors (RECIST) criteria are superior to European Association for Study of the Liver (EASL) criteria at 1 month follow-up for predicting long-term survival in patients treated with transarterial chemoembolization before liver transplantation for hepatocellular cancer (2013) J Vasc Interv Radiol, 24, pp. 805-812; Tabrizian, P., Jibara, G., Shrager, B., Schwartz, M., Roayaie, S., Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis (2015) Ann Surg, 261, pp. 947-955; Erridge, S., Pucher, P.H., Markar, S.R., Malietzis, G., Athanasiou, T., Darzi, A., Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma (2017) Br J Surg, 104, pp. 1433-1442; Serper, M., Taddei, T.H., Mehta, R., D’Addeo, K., Dai, F., Aytaman, A., Association of provider specialty and multidisciplinary care with hepatocellular carcinoma treatment and mortality (2017) Gastroenterology, 152, pp. 1954-1964

PY - 2018

Y1 - 2018

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. © 2018 by the American Association for the Study of Liver Diseases.

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. © 2018 by the American Association for the Study of Liver Diseases.

U2 - 10.1002/hep.30185

DO - 10.1002/hep.30185

M3 - Article

VL - 68

SP - 1232

EP - 1244

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 4

ER -