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

Giannini, E. G.; Moscatelli, A.; Pellegatta, G.; Vitale, A.; Farinati, F.; Ciccarese, F.; Piscaglia, F.; Rapaccini, G. L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Cabibbo, G.; Felder, M.; Sacco, R.; Morisco, F.; Missale, G.; Foschi, F. G.; Gasbarrini, A.; Baroni, G. S.; Virdone, R.; Masotto, A.; Trevisani, F.; Bolondi, L.; Biselli, M.; Caraceni, P.; Cucchetti, A.; Domenicali, M.; Gramenzi, A.; Magalotti, D.; Pecorelli, A.; Serra, C.; Venerandi, L.; Gazzola, A.; Murer, F.; Pozzan, C.; Vanin, V.; Del Poggio, P.; Olmi, S.; Balsamo, C.; Vavassori, E.; Benvegnu, L.; Capelli, A.; Golfieri, R.; Mosconi, C.; Renzulli, M.; Bosco, G.; Roselli, P.; Dell'Isola, S.; Maria Ialungo, A.; Rastrelli, E.; Picciotto, A.; Savarino, V.; Mega, A.; Rinninella, E.; Mismas, V.; Lanzi, A.; Cappa, F. M.; Musetto, A.; Neri, E.; Stefanini, G. F.; Suzzi, A.; Tamberi, S.; Triossi, O.; Chiaramonte, M.; Marchetti, F.; Valerio, M.

doi:10.1038/ajg.2015.389

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 / Giannini, E. G.; Moscatelli, A.; Pellegatta, G.; Vitale, A.; Farinati, F.; Ciccarese, F.; Piscaglia, F.; Rapaccini, G. L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Cabibbo, G.; Felder, M.; Sacco, R.; Morisco, F.; Missale, G.; Foschi, F. G.; Gasbarrini, A.; Baroni, G. S.; Virdone, R.; Masotto, A.; Trevisani, F.; Bolondi, L.; Biselli, M.; Caraceni, P.; Cucchetti, A.; Domenicali, M.; Gramenzi, A.; Magalotti, D.; Pecorelli, A.; Serra, C.; Venerandi, L.; Gazzola, A.; Murer, F.; Pozzan, C.; Vanin, V.; Del Poggio, P.; Olmi, S.; Balsamo, C.; Vavassori, E.; Benvegnu, L.; Capelli, A.; Golfieri, R.; Mosconi, C.; Renzulli, M.; Bosco, G.; Roselli, P.; Dell'Isola, S.; Maria Ialungo, A.; Rastrelli, E.; Picciotto, A.; Savarino, V.; Mega, A.; Rinninella, E.; Mismas, V.; Lanzi, A.; Cappa, F. M.; Musetto, A.; Neri, E.; Stefanini, G. F.; Suzzi, A.; Tamberi, S.; Triossi, O.; Chiaramonte, M.; Marchetti, F.; Valerio, M.. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - 111:1(2016), pp. 70-77. [10.1038/ajg.2015.389]