Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: A multicentre study

Alessandro Vitale, Patrizia Burra, Anna Chiara Frigo, Franco Trevisani, Fabio Farinati, Gaya Spolverato, Michael Volk, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Gian Lodovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Giuseppe Cabibbo, Martina Felder, Antonio Gasbarrini, Rodolfo Sacco, Francesco Giuseppe FoschiGabriele Missale, Filomena Morisco, Gianluca Svegliati Baroni, Roberto Virdone, Umberto Cillo

Research output: Contribution to journalArticle

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Abstract

Background & Aims The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. Methods Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection - MS LRT)/MS BSC. Results After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0 = 62% (40%, 82%), A = 45% (13%, 65%), B = 46% (9%, 76%), C = -16% (-55%, 33%). Model for end-stage liver disease (MELD) score >9, Child B class, and performance status (PST) = 2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD ≤9 and PST 9 or PST = 2 or Child B class), resection did not prove any survival benefit over LRT. Conclusions Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD >9) and PST >1 are absent.

Original languageEnglish
Pages (from-to)617-624
Number of pages8
JournalJournal of Hepatology
Volume62
Issue number3
DOIs
Publication statusPublished - Mar 1 2015

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Liver Neoplasms
Multicenter Studies
Hepatocellular Carcinoma
Survival
Liver
End Stage Liver Disease
Therapeutics
Liver Diseases
Logistic Models
Databases

Keywords

  • Best supportive care
  • Cirrhosis
  • Hepatocellular carcinoma
  • Liver resection
  • Loco-regional therapies
  • Survival benefit

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

Cite this

Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages : A multicentre study. / Vitale, Alessandro; Burra, Patrizia; Frigo, Anna Chiara; Trevisani, Franco; Farinati, Fabio; Spolverato, Gaya; Volk, Michael; Giannini, Edoardo G.; Ciccarese, Francesca; Piscaglia, Fabio; Rapaccini, Gian Lodovico; Di Marco, Mariella; Caturelli, Eugenio; Zoli, Marco; Borzio, Franco; Cabibbo, Giuseppe; Felder, Martina; Gasbarrini, Antonio; Sacco, Rodolfo; Foschi, Francesco Giuseppe; Missale, Gabriele; Morisco, Filomena; Svegliati Baroni, Gianluca; Virdone, Roberto; Cillo, Umberto.

In: Journal of Hepatology, Vol. 62, No. 3, 01.03.2015, p. 617-624.

Research output: Contribution to journalArticle

Vitale, A, Burra, P, Frigo, AC, Trevisani, F, Farinati, F, Spolverato, G, Volk, M, Giannini, EG, Ciccarese, F, Piscaglia, F, Rapaccini, GL, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Cabibbo, G, Felder, M, Gasbarrini, A, Sacco, R, Foschi, FG, Missale, G, Morisco, F, Svegliati Baroni, G, Virdone, R & Cillo, U 2015, 'Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: A multicentre study', Journal of Hepatology, vol. 62, no. 3, pp. 617-624. https://doi.org/10.1016/j.jhep.2014.10.037
Vitale, Alessandro ; Burra, Patrizia ; Frigo, Anna Chiara ; Trevisani, Franco ; Farinati, Fabio ; Spolverato, Gaya ; Volk, Michael ; Giannini, Edoardo G. ; Ciccarese, Francesca ; Piscaglia, Fabio ; Rapaccini, Gian Lodovico ; Di Marco, Mariella ; Caturelli, Eugenio ; Zoli, Marco ; Borzio, Franco ; Cabibbo, Giuseppe ; Felder, Martina ; Gasbarrini, Antonio ; Sacco, Rodolfo ; Foschi, Francesco Giuseppe ; Missale, Gabriele ; Morisco, Filomena ; Svegliati Baroni, Gianluca ; Virdone, Roberto ; Cillo, Umberto. / Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages : A multicentre study. In: Journal of Hepatology. 2015 ; Vol. 62, No. 3. pp. 617-624.
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abstract = "Background & Aims The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. Methods Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection - MS LRT)/MS BSC. Results After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0 = 62{\%} (40{\%}, 82{\%}), A = 45{\%} (13{\%}, 65{\%}), B = 46{\%} (9{\%}, 76{\%}), C = -16{\%} (-55{\%}, 33{\%}). Model for end-stage liver disease (MELD) score >9, Child B class, and performance status (PST) = 2 were the main risk factors for liver resection. 1181 Child A patients (57{\%}) with MELD ≤9 and PST 9 or PST = 2 or Child B class), resection did not prove any survival benefit over LRT. Conclusions Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD >9) and PST >1 are absent.",
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T1 - Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages

T2 - A multicentre study

AU - Vitale, Alessandro

AU - Burra, Patrizia

AU - Frigo, Anna Chiara

AU - Trevisani, Franco

AU - Farinati, Fabio

AU - Spolverato, Gaya

AU - Volk, Michael

AU - Giannini, Edoardo G.

AU - Ciccarese, Francesca

AU - Piscaglia, Fabio

AU - Rapaccini, Gian Lodovico

AU - Di Marco, Mariella

AU - Caturelli, Eugenio

AU - Zoli, Marco

AU - Borzio, Franco

AU - Cabibbo, Giuseppe

AU - Felder, Martina

AU - Gasbarrini, Antonio

AU - Sacco, Rodolfo

AU - Foschi, Francesco Giuseppe

AU - Missale, Gabriele

AU - Morisco, Filomena

AU - Svegliati Baroni, Gianluca

AU - Virdone, Roberto

AU - Cillo, Umberto

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background & Aims The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. Methods Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection - MS LRT)/MS BSC. Results After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0 = 62% (40%, 82%), A = 45% (13%, 65%), B = 46% (9%, 76%), C = -16% (-55%, 33%). Model for end-stage liver disease (MELD) score >9, Child B class, and performance status (PST) = 2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD ≤9 and PST 9 or PST = 2 or Child B class), resection did not prove any survival benefit over LRT. Conclusions Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD >9) and PST >1 are absent.

AB - Background & Aims The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. Methods Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection - MS LRT)/MS BSC. Results After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0 = 62% (40%, 82%), A = 45% (13%, 65%), B = 46% (9%, 76%), C = -16% (-55%, 33%). Model for end-stage liver disease (MELD) score >9, Child B class, and performance status (PST) = 2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD ≤9 and PST 9 or PST = 2 or Child B class), resection did not prove any survival benefit over LRT. Conclusions Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD >9) and PST >1 are absent.

KW - Best supportive care

KW - Cirrhosis

KW - Hepatocellular carcinoma

KW - Liver resection

KW - Loco-regional therapies

KW - Survival benefit

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