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. Morisco & 21 others L. 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)}",
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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)

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PY - 2018

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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

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