Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

Pecorelli, Anna; Lenzi, B.; Gramenzi, Annagiulia; Garuti, Francesca; Farinati, Fabio; Giannini, Edoardo G.; Ciccarese, Francesca; Piscaglia, Fabio; Rapaccini, Gian Lodovico; Marco, Maria Di; Caturelli, Eugenio; Zoli, Marco; Borzio, Franco; Sacco, Rodolfo; Cabibbo, Giuseppe; Felder, Martina; Morisco, Filomena; Gasbarrini, Antonio; Svegliati‐Baroni, Gianluca; Foschi, Francesco Giuseppe; Biasini, Elisabetta; Masotto, Alberto; Virdone, Roberto; Bernardi, Mauro; Trevisani, Franco

doi:10.1111/liv.13242

Cited by 50 publications

(60 citation statements)

References 34 publications

(76 reference statements)

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“…BCLC-B HCC. Our findings suggest that the conclusions of Pecorelli et al1 may be generalizable to patient populations and clinical contexts outside western Europe.ACKNOWLEDGEMENT The first author (J.-H.Z) thanks professor Ming-Hua Zheng, Bhavesh K. Ahir and A. Chapin Rodríguez for their kindly help of revision and suggestion of the manuscript. This work was supported by Guangxi Science and Technology Development Projects (14124003-4), the National Science and Technology Major Special DOI: 10.1111/liv.13290 Received: 26 September 2016 | Accepted: 21 October 2016 F I G U R E 1 Characteristics of patients with primary hepatocellular carcinoma (HCC) treated at our hospital from January 2003 to October 2013.…”

supporting

confidence: 65%

Hepatic resection is superior to transarterial chemoembolization for treating intermediate‐stage hepatocellular carcinoma

Zhong

Peng

You

et al. 2016

Liver International

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supporting

confidence: 65%

Hepatic resection is superior to transarterial chemoembolization for treating intermediate‐stage hepatocellular carcinoma

Zhong

Peng

You

et al. 2016

Liver International

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“…Both the BCLC and HKLC staging systems were developed in different cohorts with the intention of taking all these factors into account when recommending the most appropriate therapy for HCC. Besides the different ethnicities and HCC etiologies of the populations upon which the BCLC and HKLC staging systems were derived, the BCLC staging system has often been criticized for being too heterogeneous in its definition of stage B as well as being overly conservative[11,12]. This study adds further validation to both staging systems, as evidenced by the good separation of the survival curves when applied to our cohort of patients.…”

Section: Discussionmentioning

confidence: 74%

Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

Li¹,

Goh²,

Chang³

et al. 2017

WJG

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AIMTo compare the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) classification systems when applied to HCC patients from the largest tertiary-level centre in Singapore.METHODSOne thousand two hundred and seventy hepatocellular carcinoma (HCC) patients prospectively enrolled in a tertiary-level centre registry in Singapore since 1988 were studied. Patients were grouped into their respective BCLC and HKLC stages. Data such as demography, aetiology of HCC and type of treatment were collected. Survival data was based on census with the National Registry of Births and Deaths on 31st October 2015. Statistical analyses were done using SPSS version 21 (Chicago, IL, United States). Survival analyses were done by the Kaplan-Meier method. Differences in survival rates were compared using the log-rank test.RESULTSThe median age at presentation was 63 years (range 13-94); male 82.4%; Chinese 89.4%, Malay 7.1%, Indian, 2.8%. Hepatitis B was the predominant aetiology (75.0%; Hepatitis C 7.2%, Hepatitis B and C co-infection 3.8%, non-viral 14.0%). Both BCLC and HKLC staging systems showed good separation with overall log rank test confirming significant survival differences between stages in our cohort (P < 0.001). 206 out of the 240 patients (85.8%) assigned for curative treatment by the BCLC treatment algorithm received curative therapy for HCC [Stage 0 93.2% (68/73); Stage A 82.6% (138/167)]. In contrast, only 341/558 (61.1%) patients received curative treatment despite being assigned for curative treatment by the HKLC treatment algorithm [Stage I 72.7% (264/363); Stage II 40.2% (66/164); Stage Va 35.5% (11/31)]. Patients who were assigned to curative treatment by HKLC but did not receive curative treatment had significantly poorer ECOG (P < 0.001), higher Child-Pugh status (P < 0.001) and were older (median age 66 vs 61, P < 0.001) than those who received curative therapy. Median overall survival in patients assigned to curative treatment groups by BCLC and HKLC were 6.1 and 2.6 years respectively (P < 0.001). When only patients receiving curative treatment were analyzed, BCLC still predicted overall median survival better than HKLC (7.1 years vs 5.5 years, P = 0.037).CONCLUSIONBCLC performs better than HKLC in our multiethnic Asian population in allocating patients to curative treatment in a real-life situation as well as in predicting survival.

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“…The most prominent example of a survival benefit‐based treatment algorithm, linked to a prognostic staging system, is the Barcelona Clinic Liver Cancer (BCLC) treatment schedule . However, a limitation of this schedule is that it was not derived from a large cohort of HCC patients or real‐life clinical practices and was rather based on literature analyses and expert opinions …”

Section: Introductionmentioning

confidence: 99%

The concept of therapeutic hierarchy for patients with hepatocellular carcinoma: A multicenter cohort study

Vitale

Farinati

Pawlik

et al. 2019

Liver International

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Alessandro Vitale and Fabio Farinati equally contributed to this work.Prognosis and designing a treatment modality in patients with hepatocellular carcinoma (HCC) are extremely complex because, in most cases, this neoplasm is accompanied by the cirrhotic liver and other comorbidities. 1 Thus in such cases, tumour stage, the degree of liver function and general conditions of patients are the major deterministic factors. 2,3 A common and promising approach linking prognostic variables with therapeutic choice is to analyse large patient cohorts and, using treatment selection as the main endpoint, identify the fundamental treatment rules. An example of such a data-based approach is the HCC treatment schedule recently proposed by the Hong Kong Liver Cancer (HKLC) group. In this approach, Yau et al 4 applied an algorithm based on classification and regression tree statistical methodology to link the main treatment decision rules with HKLC tumour stages. The main limitation of this approach, however, was that the Key points• Using a large consecutive cohort of patients with hepatocellular carcinoma from Italy (n = 4,867), we showed that a clear therapeutic hierarchy exists irrespective of tumour stage, live function, patient general conditions and treatment period.• This therapeutic hierarchy, in order of survival benefit gain, follows liver transplantation, liver resection, ablation, intra-arterial therapies, systemic therapy and best supportive care.• The results of this study suggest that a personalized approach based on the therapeutic hierarchy concept should be pursued in the context of a multidisciplinary evaluation, for each patient with hepatocellular carcinoma, irrespective of the stage of the disease. AbstractBackground: The Italian Liver Cancer (ITA.LI.CA) prognostic system for patients with hepatocellular carcinoma (HCC) has recently been proposed and validated. We sought to explore the relationship among the ITA.LI.CA prognostic variables (ie tumour stage, functional score based on performance status and Child-Pugh score, and alpha-fetoprotein), treatment selection and survival outcome in HCC patients. Patients and Methods:We analysed 4,867 consecutive HCC patients undergoing six main treatment strategies (liver transplantation, LT; liver resection, LR; ablation, ABL; intra-arterial therapy, IAT; Sorafenib, SOR; and best supportive care, BSC) and enrolled during 2002-2015 in a multicenter Italian database. In order to control pretreatment imbalances in observed variables, a machine learning methodology was used and inverse probability of treatment weights (IPTW) was calculated. An IPTWadjusted multivariate survival model that included ITA.LI.CA prognostic variables, treatment period and treatment strategy was then developed. The survival benefit of HCC treatments was described as a hazard ratio (95% confidence interval), using BSC as a reference value and as predicted median survival.Results: After the IPTW, the six treatment groups became well balanced for most baseline characteristics. In the IPTW-adjust...

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Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

Cited by 50 publications

References 34 publications

Hepatic resection is superior to transarterial chemoembolization for treating intermediate‐stage hepatocellular carcinoma

Hepatic resection is superior to transarterial chemoembolization for treating intermediate‐stage hepatocellular carcinoma

Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

The concept of therapeutic hierarchy for patients with hepatocellular carcinoma: A multicenter cohort study

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