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 <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. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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, A. C.; Trevisani, F.; Farinati, F.; Spolverato, G.; Volk, M.; Giannini, E. G.; Ciccarese, F.; Piscaglia, F.; Rapaccini, G. L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Cabibbo, G.; Felder, M.; Gasbarrini, A.; Sacco, R.; Foschi, F. G.; Missale, G.; Morisco, F.; Svegliati Baroni, G.; Virdone, R.; Cillo, U.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 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

Vitale A.;Di Marco M.;Zoli M.;Missale G.;
2015-01-01

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 <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. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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, A. C.; Trevisani, F.; Farinati, F.; Spolverato, G.; Volk, M.; Giannini, E. G.; Ciccarese, F.; Piscaglia, F.; Rapaccini, G. L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Cabibbo, G.; Felder, M.; Gasbarrini, A.; Sacco, R.; Foschi, F. G.; Missale, G.; Morisco, F.; Svegliati Baroni, G.; Virdone, R.; Cillo, U.. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 62:3(2015), pp. 617-624. [10.1016/j.jhep.2014.10.037]
File in questo prodotto:
File Dimensione Formato  
JHEPAT-D-14-00852R3 (2).pdf

Open Access dal 02/03/2016

Tipologia: Documento in Post-print
Licenza: Creative commons
Dimensione 745.46 kB
Formato Adobe PDF
745.46 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2868027
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 135
  • ???jsp.display-item.citation.isi??? 146
social impact