OBJECTIVES:The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group.METHODS:We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages.RESULTS:Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P<0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P<0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P<0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival.CONCLUSIONS:The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients.

Application of the Intermediate-Stage Subclassification to Patients with Untreated Hepatocellular Carcinoma

PISCAGLIA, FABIO;ZOLI, MARCO;TREVISANI, FRANCO;BOLONDI, LUIGI;BISELLI, MAURIZIO;CARACENI, PAOLO;CUCCHETTI, ALESSANDRO;DOMENICALI, MARCO;GRAMENZI, ANNAGIULIA;Golfieri, Rita;
2016

Abstract

OBJECTIVES:The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group.METHODS:We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages.RESULTS:Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P<0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P<0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P<0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival.CONCLUSIONS:The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients.
2016
Giannini, Edoardo G; Moscatelli, Alessandro; Pellegatta, Gaia; Vitale, Alessandro; Farinati, Fabio; Ciccarese, Francesca; Piscaglia, Fabio; Rapaccini, Gian Lodovico; Di Marco, Maria; Caturelli, Eugenio; Zoli, Marco; Borzio, Franco; Cabibbo, Giuseppe; Felder, Martina; Sacco, Rodolfo; Morisco, Filomena; Missale, Gabriele; Foschi, Francesco Giuseppe; Gasbarrini, Antonio; Baroni, Gianluca Svegliati; Virdone, Roberto; Masotto, Alberto; Trevisani, Franco; Bolondi, Luigi; Biselli, Maurizio; Caraceni, Paolo; Cucchetti, Alessandro; Domenicali, Marco; Gramenzi, Annagiulia; Magalotti, Donatella; Pecorelli, Anna; Serra, Carla; Venerandi, Laura; Gazzola, Alessia; Murer, Francesca; Pozzan, Caterina; Vanin, Veronica; Del Poggio, Paolo; Olmi, Stefano; Balsamo, Claudia; Vavassori, Elena; Benvegnù, Luisa; Capelli, Alberta; Golfieri, Rita; Mosconi, Cristina; Renzulli, Matteo; Bosco, Giulia; Roselli, Paola; Dell'Isola, Serena; Maria Ialungo, Anna; Rastrelli, Elena; Picciotto, Antonino; Savarino, Vincenzo; Mega, Andrea; Rinninella, Emanuele; Mismas, Valeria; Lanzi, Arianna; Cappa, Federica Mirici; Musetto, Alessandro; Neri, Elga; Stefanini, Giuseppe Francesco; Suzzi, Alessandra; Tamberi, Stefano; Triossi, Omero; Chiaramonte, Maria; Marchetti, Fabiana; Valerio, Matteo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/561051
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