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 69 and PST <2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0 = 64% (44%, 85%), A = 59% (45%, 74%), B = 71% (52%, 90%), C = 56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD >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.
Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study / 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; Italian Liver Cancer (ITA.LI.CA) group; Bernardi M; Bolondi L; Biselli M; Caraceni P; Cucchetti A; Domenicali M; Gramenzi A. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - STAMPA. - 62:3(2015), pp. 617-624. [10.1016/j.jhep.2014.10.037]
Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study
TREVISANI, FRANCO;PISCAGLIA, FABIO;ZOLI, MARCO;BERNARDI, MAURO;BOLONDI, LUIGI;BISELLI, MAURIZIO;CARACENI, PAOLO;CUCCHETTI, ALESSANDRO;DOMENICALI, MARCO;GRAMENZI, ANNAGIULIA
2015
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 69 and PST <2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0 = 64% (44%, 85%), A = 59% (45%, 74%), B = 71% (52%, 90%), C = 56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD >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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.