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1. Pattern of macrovascular invasion in hepatocellular carcinoma

Author

Guarino, M., Cucchetti, A., Pontillo, G., Farinati, F., Benevento, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Rodolfo, S., Cabibbo, G., Marra, F., Mega, A., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Giannini, E. G., Morisco, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Rampoldi, D., Santi, V., Forgione, A., Granito, A., Muratori, L., Piscaglia, F., Sansone, V., Tovoli, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Cela, E. M., Facciorusso, A., Pelizzaro, F., Imondi, A., Sartori, A., Penzo, B., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., Pieri, G., de Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Olivari, A., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Berardinelli, D., Ercolani, G., Napoli, L., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Capasso, M., Fiorentino, A., Pignata, L., Cossiga, V., Romagnoli, V., Guarino M., Cucchetti A., Pontillo G., Farinati F., Benevento F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Rodolfo S., Cabibbo G., Marra F., Mega A., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Missale G., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Oliveri F., Trevisani F., Giannini E.G., Morisco F., Biselli M., Caraceni P., Garuti F., Gramenzi A., Neri A., Rampoldi D., Santi V., Forgione A., Granito A., Muratori L., Piscaglia F., Sansone V., Tovoli F., Dajti E., Marasco G., Ravaioli F., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Cela E.M., Facciorusso A., Pelizzaro F., Imondi A., Sartori A., Penzo B., Cacciato V., Casagrande E., Moscatelli A., Pellegatta G., Pieri G., de Matthaeis N., Allegrini G., Lauria V., Ghittoni G., Pelecca G., Chegai F., Coratella F., Ortenzi M., Olivari A., Inno A., Marchetti F., Busacca A., Camma C., Di Martino V., Rizzo G.E.M., Franze M.S., Saitta C., Sauchella A., Bevilacqua V., Borghi A., Gardini A.C., Conti F., Berardinelli D., Ercolani G., Napoli L., Campani C., Di Bonaventura C., Gitto S., Coccoli P., Malerba A., Capasso M., Fiorentino A., Pignata L., Cossiga V., Romagnoli V., Guarino, M., Cucchetti, A., Pontillo, G., Farinati, F., Benevento, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Rodolfo, S., Cabibbo, G., Marra, F., Mega, A., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Giannini, E. G., Morisco, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Rampoldi, D., Santi, V., Forgione, A., Granito, A., Muratori, L., Piscaglia, F., Sansone, V., Tovoli, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Cela, E. M., Facciorusso, A., Pelizzaro, F., Imondi, A., Sartori, A., Penzo, B., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., Pieri, G., de Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Olivari, A., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Berardinelli, D., Ercolani, G., Napoli, L., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Capasso, M., Fiorentino, A., Pignata, L., Cossiga, V., and Romagnoli, V.

Subjects
Ablation Techniques, Male, Registrie, Cirrhosis, Clinical Biochemistry, Mesenteric Vein, loco-regional treatment, 030204 cardiovascular system & hematology, Biochemistry, Gastroenterology, surgery, Antineoplastic Agent, Liver disease, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, cirrhosis, hepatocellular carcinoma, portal vein thrombosis, transplantation, Ascites, Ablation Technique, Registries, 030212 general & internal medicine, Chronic, Settore MED/12 - Gastroenterologia, Portal Vein, Liver Diseases, Liver Neoplasms, General Medicine, Middle Aged, Sorafenib, Prognosis, Hepatitis B, Alcoholic, Hepatitis C, Tumor Burden, Survival Rate, Italy, Liver Neoplasm, Hepatocellular carcinoma, Ascite, Female, medicine.symptom, Liver cancer, Human, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Antineoplastic Agents, End Stage Liver Disease, 03 medical and health sciences, Mesenteric Veins, Hepatitis B, Chronic, Internal medicine, medicine, Humans, Hepatectomy, Neoplasm Invasiveness, portal vein thrombosi, Liver Diseases, Alcoholic, Aged, Neoplasm Invasivene, Performance status, business.industry, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Patient Acuity, Hepatocellular, Hepatitis C, Chronic, medicine.disease, Liver Transplantation, Transplantation, Liver function, business, cirrhosi
Abstract

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4months in those with PS>1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Published
2021

2. Hepatocellular carcinoma recurrence in patients with curative resection or ablation: impact of HCV eradication does not depend on the use of interferon

Author

Petta, S., Cabibbo, G., Barbara, M., Attardo, S., Bucci, L., Farinati, F., Giannini, E. G., Tovoli, F., Ciccarese, F., Rapaccini, Gian Ludovico, Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Virdone, R., Marra, F., Felder, M., Morisco, F., Benvegnù, L., Gasbarrini, Antonio, Svegliati-Baroni, G., Foschi, F. G., Olivani, A., Masotto, A., Nardone, G., Colecchia, A., Persico, M., Boccaccio, V., Craxì, A., Bruno, S., Trevisani, F., Cammà, C, Biselli, Maurizio, Caraceni, Paolo, Cucchetti, Alessandro, Domenicali, Marco, Piscaglia, Fabio, Gramenzi, Annagiulia, Granito, Alessandro, Magalotti, Donatella, Serra, Carla, Negrini, Giulia, Napoli, L., Napoli, Lucia, Salvatore, Veronica, Benevento, Francesca, Gazzola, Alessia, Murer, Francesca, Pozzan, Caterina, Vanin, Veronica, Moscatelli, Alessandro, Pellegatta, Gaia, Picciotto, Antonino, Savarino, Vincenzo, Delpoggio, Paolo, Olmi, Stefano, De Matthaeis, Nicoletta, Balsamo, Claudia, Vavassori, Elena, Roselli, Paola, Dell’Isola, Serena, Ialungo, Anna Maria, Rastrelli, Elena, Rini, Francesca, Costantino, Andrea, Affronti, Andrea, Affronti, Marco, Mascari, Marta, Mega, Andrea, Pompili, Maurizio, Rinninella, Emanuele, Mismas, Valeria, Dall’Aglio, Anna Chiara, Feletti, Valentina, Lanzi, Arianna, Cappa, Federica Mirici, Neri, Elga, Stefanini, Giuseppe Francesco, Tamberi, Stefano, Biasini, Elisabetta, Missale, Gabriele, Guarino, Maria, Ortolani, Alessio, Chiaramonte, Maria, Marchetti, Fabiana, Valerio, Matteo, Aburas, Sami, Inghilesi, Andrea L., Cappelli, Alberta, Golfieri, Rita, Mosconi, Cristina, Renzulli, Matteo, Coccoli, Piero, Zamparelli, Marco Sanduzzi, Petta, Salvatore, Cabibbo, Giuseppe, Barbara, Marco, Attardo, Simona, Bucci, Laura, Farinati, Fabio, Giannini, Edoardo G., Tovoli, Francesco, Ciccarese, Francesca, Rapaccini, Gian Lodovico, Dimarco, Maria, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Sacco, Rodolfo, Virdone, Roberto, Marra, Fabio, Felder, Martina, Morisco, Filomena, Benvegnù, Luisa, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Colecchia, Antonio, Persico, Marcello, Boccaccio, Vincenzo, Craxì, Antonio, Bruno, Savino, Trevisani, Franco, Cammà, Calogero, Petta, S, Cabibbo, G, Barbara, M, Attardo, S, Bucci, L, Farinati, F, Giannini, E. G, Tovoli, F, Ciccarese, F, Rapaccini, G. L, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Virdone, R, Marra, F, Felder, M, Morisco, Filomena, Benvegnù, L, Gasbarrini, A, Svegliati Baroni, G, Foschi, F. G, Olivani, A, Masotto, A, Nardone, GERARDO ANTONIO PIO, Colecchia, A, Persico, M, Boccaccio, V, Craxì, A, Bruno, S, Trevisani, F, Cammà, C., DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, DIPARTIMENTO DI SCIENZE MEDICHE E CHIRURGICHE, Facolta' di MEDICINA e CHIRURGIA, Da definire, AREA MIN. 06 - Scienze mediche, Petta, S., Cabibbo, G., Barbara, M., Attardo, S., Bucci, L., Farinati, F., Giannini, E., Tovoli, F., Ciccarese, F., Rapaccini, G., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Virdone, R., Marra, F., Felder, M., Morisco, F., Benvegnã¹, L., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F., Olivani, A., Masotto, A., Nardone, G., Colecchia, A., Persico, M., Boccaccio, V., Craxi, A., Bruno, S., Trevisani, F., Camma', C., Biselli, M., Caraceni, P., Cucchetti, A., Domenicali, M., Piscaglia, F., Gramenzi, A., Granito, A., Magalotti, D., Serra, C., Negrini, G., Napoli, L., Salvatore, V., Benevento, F., Gazzola, A., Murer, F., Pozzan, C., Vanin, V., Moscatelli, A., Pellegatta, G., Picciotto, A., Savarino, V., Delpoggio, P., Olmi, S., Dematthaeis, N., Balsamo, C., Vavassori, E., Roselli, P., Dell’Isola, S., Ialungo, A., Rastrelli, E., Rini, F., Costantino, A., Affronti, A., Affronti, M., Mascari, M., Mega, A., Pompili, M., Rinninella, E., Mismas, V., Dall’Aglio, A., Feletti, V., Lanzi, A., Cappa, F., Neri, E., Stefanini, G., Tamberi, S., Biasini, E., Missale, G., Guarino, M., Ortolani, A., Chiaramonte, M., Marchetti, F., Valerio, M., Aburas, S., Inghilesi, A., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Coccoli, P., Zamparelli, M., Giannini, E.G., Rapaccini, G.L., Benvegnù, L., Foschi, F.G., Craxì, A., Cammà, C, the Italian Liver Cancer (ITALICA) Group [, Maurizio Biselli, Paolo Caraceni, Alessandro Cucchetti, Marco Domenicali, Fabio Piscaglia, Annagiulia Gramenzi, Alessandro Granito, Donatella Magalotti, Carla Serra, Giulia Negrini, Lucia Napoli, Veronica Salvatore, Francesca Benevento, ], Giannini, E. G., Rapaccini, G. L., Benvegnu, L., Foschi, F. G., Camma, C., Dell'Isola, S., Ialungo, A. M., Dall'Aglio, A. C., Cappa, F. M., Stefanini, G. F., Inghilesi, A. L., and Zamparelli, M. S.

Subjects
Liver Cirrhosis, Male, Cirrhosis, Databases, Factual, Gastroenterology, HCV-infected cirrhotic patients, hepatocellular carcinoma, HCC, sustained viral eradication, SVR, interferon, 0302 clinical medicine, Retrospective Studie, Pharmacology (medical), Prospective Studies, Prospective cohort study, Aged, 80 and over, Liver Neoplasms, virus diseases, Hepatitis C, Middle Aged, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Catheter Ablation, Interferon, 030211 gastroenterology & hepatology, Female, Liver cancer, Human, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Liver Cirrhosi, Antiviral Agents, Follow-Up Studie, 03 medical and health sciences, Internal medicine, medicine, Carcinoma, Early Hepatocellular Carcinoma, Humans, Aged, Retrospective Studies, Antiviral Agent, Hepatology, business.industry, Settore MED/09 - MEDICINA INTERNA, Retrospective cohort study, medicine.disease, digestive system diseases, Surgery, Prospective Studie, Interferons, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

none 48 no Background: In HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma (HCC), the time to HCC recurrence and the effects of sustained viral eradication (SVR) by interferon (IFN)-based or IFN-free regimens on HCC recurrence remain unclear. Aim: To perform an indirect comparison of time to recurrence (TTR) in patients with successfully treated early HCC and active HCV infection with those of patients with SVR by IFN-based and by IFN-free regimens. Methods: We evaluated 443 patients with HCV-related cirrhosis and Barcelona Clinic Liver Cancer Stage A/0 HCC who had a complete radiological response after curative resection or ablation. Active HCV infection was present in 328, selected from the Italian Liver Cancer group cohort; 58 patients had SVR achieved by IFN-free regimens after HCC cure, and 57 patients had SVR achieved by IFN-based regimens after HCC cure. Individual data of patients in the last two groups were extracted from available publications. Results: TTR by Kaplan–Meier curve was significantly lower in patients with active HCV infection compared with those with SVR both by IFN-free (P = 0.02) and by IFN-based (P < 0.001) treatments. TTR was similar in patients with SVR by IFN-free or by IFN-based (P = 0.49) strategies. Conclusion: In HCV-infected, successfully treated patients with early HCC, SVR obtained by IFN-based or IFN-free regimens significantly reduce tumour recurrence without differences related to the anti-viral strategy used. Petta, S.; Cabibbo, G.; Barbara, M.; Attardo, S.; Bucci, L.; Farinati, F.; Giannini, E.G.; Tovoli, F.; Ciccarese, F.; Rapaccini, G.L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Sacco, R.; Virdone, R.; Marra, F.; Felder, M.; Morisco, F.; Benvegnù, L.; Gasbarrini, A.; Svegliati-Baroni, G.; Foschi, F.G.; Olivani, A.; Masotto, A.; Nardone, G.; Colecchia, A.; Persico, M.; Boccaccio, V.; Craxì, A.; Bruno, S.; Trevisani, F.; Cammà, C; the Italian Liver Cancer (ITALICA) Group [ ; Maurizio Biselli; Paolo Caraceni; Alessandro Cucchetti; Marco Domenicali; Fabio Piscaglia; Annagiulia Gramenzi; Alessandro Granito; Donatella Magalotti; Carla Serra; Giulia Negrini; Lucia Napoli; Veronica Salvatore; Francesca Benevento;] Petta, S.; Cabibbo, G.; Barbara, M.; Attardo, S.; Bucci, L.; Farinati, F.; Giannini, E.G.; Tovoli, F.; Ciccarese, F.; Rapaccini, G.L.; Di Marco, M.; Caturelli, E.; Zoli, M.; Borzio, F.; Sacco, R.; Virdone, R.; Marra, F.; Felder, M.; Morisco, F.; Benvegnù, L.; Gasbarrini, A.; Svegliati-Baroni, G.; Foschi, F.G.; Olivani, A.; Masotto, A.; Nardone, G.; Colecchia, A.; Persico, M.; Boccaccio, V.; Craxì, A.; Bruno, S.; Trevisani, F.; Cammà, C; the Italian Liver Cancer (ITALICA) Group [ ; Maurizio Biselli; Paolo Caraceni; Alessandro Cucchetti; Marco Domenicali; Fabio Piscaglia; Annagiulia Gramenzi; Alessandro Granito; Donatella Magalotti; Carla Serra; Giulia Negrini; Lucia Napoli; Veronica Salvatore; Francesca Benevento;]

Published
2017

3. Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: A pilot case-control study

Author

Morisco, Filomena, Camera, Silvia, Guarino, Maria, Tortora, Raffaella, Cossiga, Valentina, Vitiello, Anna, Cordone, Gabriella, Caporaso, Nicola, Di Costanzo, Giovan Giuseppe, Zoli, M., Garuti, F., Neri, A., Piscaglia, F., Lenzi, B., Valente, M., Trevisani, F., Bolondi, L., Biselli, M., Caraceni, P., Cucchetti, A., Domenicali, M., Gramenzi, A., Magalotti, D., Serra, C., Venerandi, L., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Giannini, E. G., Brunacci, M., Moscatelli, A., Pellegatta, G., Savarino, V., Caturelli, E., Roselli, P., Lauria, V., Pelecca, G., Dell'Isola, S., Ialungo, A. M., Rastrelli, E., Cabibbo, G., Cammà, C., Attardo, S., Rossi, M., Cavani, G., Virdone, R., Affronti, A., Nardone, G., Felder, M., Mega, A., Ciccarese, F., Del Poggio, P., Olmi, S., Foschi, F. G., Bevilacqua, V., Dall'Aglio, A. C., Ercolani, G., Fiorini, E., Casadei Gardini, A., Lanzi, A., Mirici Cappa, F., Sacco, R., Mismas, V., Svegliati Barone, G., Schiadà, L., Farinati, F., Gazzola, A., Murer, F., Pozzan, C., Vanin, V., Rapaccini, G. L., de Matthaeis, N., Gasbarrini, A., Rinninella, E., Olivani, A., Missale, G., Biasini, E., Di Marco, M., Balsamo, C., Vavassori, E., Masotto, A., Marchetti, F., Valerio, M., Marra, F., Aburas, S., Campani, C., Dragoni, G., Borzio, F., Benvegnù, L., Festi, D., Marasco, Giovanni, Ravaioli, Federico, Morisco, Filomena, Camera, Silvia, Guarino, Maria, Tortora, Raffaella, Cossiga, Valentina, Vitiello, Anna, Cordone, Gabriella, Caporaso, Nicola, Di Costanzo, Giovan Giuseppe, Zoli, M., Garuti, F., Neri, A., Piscaglia, F., Lenzi, B., Valente, M., Trevisani, F., Bolondi, L., Biselli, M., Caraceni, P., Cucchetti, A., Domenicali, M., Gramenzi, A., Magalotti, D., Serra, C., Venerandi, L., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Giannini, E.G., Brunacci, M., Moscatelli, A., Pellegatta, G., Savarino, V., Caturelli, E., Roselli, P., Lauria, V., Pelecca, G., Dell'Isola, S., Ialungo, A.M., Rastrelli, E., Cabibbo, G., Cammà, C., Attardo, S., Rossi, M., Cavani, G., Virdone, R., Affronti, A., Nardone, G., Felder, M., Mega, A., Ciccarese, F., Del Poggio, P., Olmi, S., Foschi, F.G., Bevilacqua, V., Dall'Aglio, A.C., Ercolani, G., Fiorini, E., Casadei Gardini, A., Lanzi, A., Mirici Cappa, F., Sacco, R., Mismas, V., Svegliati Barone, G., Schiadà, L., Farinati, F., Gazzola, A., Murer, F., Pozzan, C., Vanin, V., Rapaccini, G.L., de Matthaeis, N., Gasbarrini, A., Rinninella, E., Olivani, A., Missale, G., Biasini, E., Di Marco, M., Balsamo, C., Vavassori, E., Masotto, A., Marchetti, F., Valerio, M., Marra, F., Aburas, S., Campani, C., Dragoni, G., Borzio, F., Benvegnù, L., Festi, D., Marasco, Giovanni, Ravaioli, Federico, Giannini, E. G., Ialungo, A. M., Foschi, F. G., Dall'Aglio, A. C., Rapaccini, G. L., Garuti, Franca, Venerandi, Laura, Mega, Angela, Fiorini, Elisabetta, Lanzi, Andrea, and Balsamo, Carlo

Subjects
medicine.medical_specialty, Large HCC, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Survival rate, Laser ablation, TACE, Univariate analysis, business.industry, Standard treatment, Large HCC, Laser ablation, TACE, Oncology, Cancer, Hepatology, medicine.disease, BCLC Stage, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, Liver cancer, business, Research Paper
Abstract

// Filomena Morisco 1 , Silvia Camera 1 , Maria Guarino 1 , Raffaella Tortora 2 , Valentina Cossiga 1 , Anna Vitiello 1 , Gabriella Cordone 2 , Nicola Caporaso 1 , Giovan Giuseppe Di Costanzo 2 and Italian Liver Cancer (ITA.LI.CA) group 1 Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy 2 Hepatology Unit, “Cardarelli” Hospital, Naples, Italy Correspondence to: Filomena Morisco, email: filomena.morisco@unina.it Keywords: large HCC; laser ablation; TACE Received: December 13, 2017 Accepted: February 27, 2018 Published: April 03, 2018 ABSTRACT Background: Limited therapies are available for large (≥40 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC. Methods: Eighty-two patients with a single HCC nodule ≥40 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up. Results: Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively ( p 60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively ( p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively. Conclusions: LA is a more effective therapeutic option than TACE in patients with solitary large HCC.

Published
2018

4. Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice

Author

Giannini E. G., Bucci L., Garuti F., Brunacci M., Lenzi B., Valente M., Caturelli E., Cabibbo G., Piscaglia F., Virdone R., Felder M., Ciccarese F., Foschi F. G., Sacco R., Svegliati Baroni G., Farinati F., Rapaccini G. L., Olivani A., Gasbarrini A., Di Marco M., Morisco F., Zoli M., Masotto A., Borzio F., Benvegnu L., Marra F., Colecchia A., Nardone G., Bernardi M., Trevisani F, Olmi S, on behalf of Italian Liver Cancer (ITA. LI. CA) group, Giannini, E. G., Bucci, L., Garuti, F., Brunacci, M., Lenzi, B., Valente, M., Caturelli, E., Cabibbo, G., Piscaglia, F., Virdone, R., Felder, M., Ciccarese, F., Foschi, F. G., Sacco, R., Svegliati Baroni, G., Farinati, F., Rapaccini, G. L., Olivani, A., Gasbarrini, A., Di Marco, M., Morisco, F., Zoli, M., Masotto, A., Borzio, F., Benvegnu, L., Marra, F., Colecchia, A., Nardone, G., Bernardi, M., Trevisani, F, Olmi, S, on behalf of Italian Liver Cancer (ITA. LI., CA) group, Giannini EG, Bucci L, Garuti F, Brunacci M, Lenzi B, Valente M, Caturelli E, Cabibbo G, Piscaglia F, Virdone R, Felder M, Ciccarese F, Foschi FG, Sacco R, Svegliati Baroni G, Farinati F, Rapaccini GL, Olivani A, Gasbarrini A, Di Marco M, Morisco F, Zoli M, Masotto A, Borzio F, Benvegnù L, Marra F, Colecchia A, Nardone G, Bernardi M, Trevisani F, Giannini, Edoardo G, Bucci, Laura, Garuti, Francesca, Brunacci, Matteo, Lenzi, Barbara, Valente, Matteo, Caturelli, Eugenio, Cabibbo, Giuseppe, Piscaglia, Fabio, Virdone, Roberto, Felder, Martina, Ciccarese, Francesca, Foschi, Francesco Giuseppe, Sacco, Rodolfo, Baroni, Gianluca Svegliati, Farinati, Fabio, Rapaccini, Gian Lodovico, Olivani, Andrea, Gasbarrini, Antonio, Di Marco, Maria, Morisco, Filomena, Zoli, Marco, Masotto, Alberto, Borzio, Franco, Benvegnù, Luisa, Marra, Fabio, Colecchia, Antonio, Nardone, Gerardo, Bernardi, Mauro, and Trevisani, Franco

Subjects
Sorafenib, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Databases, Factual, Settore MED/12 - GASTROENTEROLOGIA, advanced stage, Gastroenterology, survival, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, medicine, Carcinoma, Humans, Stage (cooking), Precision Medicine, Cancer staging, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, therapy, Hepatology, Performance status, business.industry, Liver Neoplasms, Middle Aged, medicine.disease, Prognosis, Survival Analysis, Liver cancer, sorafenib, Liver cancer, advanced stage, sorafenib, survival, therapy, Treatment Outcome, Liver, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, Female, alpha-Fetoproteins, business, medicine.drug
Abstract

The Barcelona Clinic Liver Cancer advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study our aim was to assess treatment and overall survival (OS) of BCLC C patients sub-classified according to clinical features (Performance Status [PS], macro-vascular invasion [MVI], extra-hepatic spread [EHS] or MVI+EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analysed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were sub-classified as: PS1 alone (n=385, 46.1%), PS2 alone (n=146, 17.5%), MVI (n=224, 26.8%), EHS (n=51, 6.1%) and MVI+EHS (n=29, 3.5%). MVI, EHS and MVI+EHS patients had larger and multifocal/massive HCCs and higher alpha-fetoprotein levels than PS1 and PS2 patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months) and MVI+EHS (3.1 months) (P

Published
2018

5. Metabolic disorders across hepatocellular carcinoma in Italy

Author

Morisco, F., Guarino, M., Valvano, M. R., Auriemma, F., Farinati, F., Giannini, E. G., Ciccarese, F., Tovoli, F., Rapaccini, Gian Ludovico, Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Cabibbo, G., Felder, M., Benvengu, L., Gasbarrini, Antonio, Svegliati Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Virdone, R., Marra, F., Caporaso, N., Trevisani, F., Sessa, A., Marafatto, F., Peserico, G., Pozzan, C., Brunacci, M., Moscatelli, A., Pellegatta, G., Savarino, V., Del Poggio, P., Olmi, S., De Matthaeis, Nicoletta, Balsamo, C., Vavassori, E., Roselli, P., Lauria, V., Pelecca, G., Mismas, V., Rossi, M., Attardo, S., Cavani, G., Mega, A., Rinninella, Emanuele, Ortolani, A., Bevilacqua, V., Chiara Dall'Aglio, A., Ercolani, G., Fiorini, Carlo Ettore, Casadei Gardini, A., Lanzi, Alessio, Mirici Cappa, F., Missale, G., Porro, E., Marchetti, F., Valerio, M., Affronti, A., Orlando, E., Rosa Barcellona, M., Aburas, S., Dragoni, G., Campani, C., Biselli, M., Bucci, L., Caraceni, P., Cucchetti, A., Domenicali, M., Garuti, F., Gramenzi, A., Magalotti, D., Serra, C., Granito, A., Negrini, G., Napoli, L., Piscaglia, F., Morisco, F., Guarino, M., Valvano, M. R., Auriemma, F., Farinati, F., Giannini, E. G., Ciccarese, F., Tovoli, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Cabibbo, G., Felder, M., Benvengu, L., Gasbarrini, A., Svegliati Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Virdone, R., Marra, F., Caporaso, N., Trevisani, F., Sessa, A., Marafatto, F., Peserico, G., Pozzan, C., Brunacci, M., Moscatelli, A., Pellegatta, G., Savarino, V., Del Poggio, P., Olmi, S., de Matthaeis, N., Balsamo, C., Vavassori, E., Roselli, P., Lauria, V., Pelecca, G., Mismas, V., Rossi, M., Attardo, S., Cavani, G., Mega, A., Rinninella, E., Ortolani, A., Bevilacqua, V., Chiara Dall'Aglio, A., Ercolani, G., Fiorini, E., Casadei Gardini, A., Lanzi, A., Mirici Cappa, F., Missale, G., Porro, E., Marchetti, F., Valerio, M., Affronti, A., Orlando, E., Rosa Barcellona, M., Aburas, S., Dragoni, G., Campani, C., Biselli, M., Bucci, L., Caraceni, P., Cucchetti, A., Domenicali, M., Garuti, F., Gramenzi, A., Magalotti, D., Serra, C., Granito, A., Negrini, G., Napoli, L., Piscaglia, F., Morisco, Filomena, Guarino, Maria, Valvano, Maria R., Auriemma, Francesco, Farinati, Fabio, Giannini, Edoardo G., Ciccarese, Francesca, Tovoli, Francesco, Rapaccini, Gian Ludovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Sacco, Rodolfo, Cabibbo, Giuseppe, Felder, Martina, Benvengù, Luisa, Gasbarrini, Antonio, Svegliati Baroni, Gianluca, Foschi, Francesco G., Biasini, Elisabetta, Masotto, Alberto, Virdone, Roberto, Marra, Fabio, Caporaso, Nicola, Trevisani, Franco, Sessa, Anna, Marafatto, Filippo, Peserico, Giulia, Pozzan, Caterina, Brunacci, Matteo, Moscatelli, Alessandro, Pellegatta, Gaia, Savarino, Vincenzo, Del Poggio, Paolo, Olmi, Stefano, de Matthaeis, Nicoletta, Balsamo, Claudia, Vavassori, Elena, Roselli, Paola, Lauria, Valentina, Pelecca, Giorgio, Mismas, Valeria, Rossi, Margherita, Attardo, Simona, Cavani, Giulia, Mega, Andrea, Rinninella, Emanuele, Ortolani, Alessio, Bevilacqua, Vittoria, Chiara Dall'Aglio, Anna, Ercolani, Giorgio, Fiorini, Erica, Casadei Gardini, Andrea, Lanzi, Arianna, Mirici Cappa, Federica, Missale, Gabriele, Porro, Emanuela, Marchetti, Fabiana, Valerio, Matteo, Affronti, Andrea, Orlando, Emanuele, Rosa Barcellona, Maria, Aburas, Sami, Dragoni, Gabriele, Campani, Claudia, Biselli, Maurizio, Bucci, Laura, Caraceni, Paolo, Cucchetti, Alessandro, Domenicali, Marco, Garuti, Francesca, Gramenzi, Annagiulia, Magalotti, Donatella, Serra, Carla, Granito, Alessandro, Negrini, Giulia, Napoli, Lucia, Piscaglia, Fabio, Valvano, Maria R, Giannini, Edoardo G, and Foschi, Francesco G

Subjects
Oncology, Male, obesity, Databases, Factual, Hepatocellular carcinoma, 0302 clinical medicine, Risk Factors, Prospective cohort study, diabetes, Metabolic disorder, Liver Neoplasms, Diabetes, hepatocellular carcinoma, Middle Aged, Metabolic syndrome, Portal vein thrombosis, Italy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, medicine.medical_specialty, Carcinoma, Hepatocellular, Settore MED/12 - GASTROENTEROLOGIA, Obesity, metabolic syndrome, 03 medical and health sciences, Databases, Metabolic Diseases, Internal medicine, medicine, Diabetes Mellitus, Humans, Factual, Aged, Neoplasm Staging, Retrospective Studies, Hepatology, business.industry, Carcinoma, Hepatocellular, medicine.disease, Survival Analysis, BCLC Stage, Multivariate Analysis, diabete, Liver function, business
Abstract

Background: Metabolic disorders are well-known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its aetiology. Methods: We analysed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analysed: BMI, diabetes, arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia. According to these features, patients were divided into 3 groups: 0-1, 2 and 3-5 metabolic features. Results: As compared with patients with 0-1 metabolic features, patients with 3-5 features showed lower percentage of HCC diagnosis on surveillance (P=.021), larger tumours (P=.038), better liver function (higher percentage of Child-Pugh class A [P=.007] and MELD&nbsp

Published
2018

6. Estimation of lead-time bias and its impact on the outcome of surveillance for the early diagnosis of hepatocellular carcinoma

Author

Cucchetti A., Trevisani F., Pecorelli A., Erroi V., Farinati F., Ciccarese F., Rapaccini G. L., Di Marco M., Caturelli E., Giannini E. G., Zoli M., Borzio F., Cabibbo G., Felder M., Gasbarrini A., Sacco R., Foschi F. G., Missale G., Morisco F., Baroni G. S., Virdone R., Bernardi M., Pinna A. D., Bolondi L., Biselli M., Caraceni P., Garuti F., Gramenzi A., Lenzi B., Magalotti D., Piscaglia F., Serra C., Ravaioli M., Venerandi L., Del Poggio P., Olmi S., Balsamo C., Di Nolfo M. A., Vavassori E., Alberti A., Benvegnu L., Gatta A., Giacomin A., Vanin V., Pozzan C., Maddalo G., Giampalma E., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Dell'Isola S., Ialungo A. M., Roselli P., Risso D., Marenco S., Sammito G., Bruzzone L., Bosco G., Grieco A., Pompili M., Rinninella E., Siciliano M., Chiaramonte M., Guarino M., Camma C., Maida M., Di Martino A., Barcellona M. R., Schiada L., Gemini S., Biasini E., Porro E., del Ricambio M., Mismas V., Vivaldi C., Cucchetti, A, Trevisani, F, Pecorelli, A, Erroi, V, Farinati, F, Ciccarese, F, Rapaccini, Gl, Di Marco, M, Caturelli, E, Giannini, Eg, Zoli, M, Borzio, F, Cabibbo, G, Felder, M, Gasbarrini, A, Sacco, R, Foschi, Fg, Missale, G, Morisco, Filomena, Baroni, G, Virdone, R, Bernardi, M, Pinna, Ad, Italian Liver Cancer, Group, Alessandro, Cucchetti, Franco, Trevisani, Anna, Pecorelli, Virginia, Erroi, Fabio, Farinati, Francesca, Ciccarese, Gian, Lodovico Rapaccini, Mariella Di, Marco, Eugenio, Caturelli, Edoardo, G. Giannini, Marco, Zoli, Franco, Borzio, Giuseppe, Cabibbo, Martina, Felder, Antonio, Gasbarrini, Rodolfo, Sacco, Francesco, Giuseppe Foschi, Gabriele, Missale, Filomena, Morisco, Gianluca, Svegliati Baroni, Roberto, Virdone, Mauro, Bernardi, Antonio D., Pinna, for the Italian Liver Cancer Group [.., Bolondi, Luigi, Maurizio, Biselli, Piscaglia, Fabio, ]., Cucchetti, A., Trevisani, F., Pecorelli, A., Erroi, V., Farinati, F., Ciccarese, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Giannini, E. G., Zoli, M., Borzio, F., Cabibbo, G., Felder, M., Gasbarrini, A., Sacco, R., Foschi, F. G., Missale, G., Morisco, F., Baroni, G. S., Virdone, R., Bernardi, M., Pinna, A. D., Bolondi, L., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Lenzi, B., Magalotti, D., Piscaglia, F., Serra, C., Ravaioli, M., Venerandi, L., Del Poggio, P., Olmi, S., Balsamo, C., Di Nolfo, M. A., Vavassori, E., Alberti, A., Benvegnu, L., Gatta, A., Giacomin, A., Vanin, V., Pozzan, C., Maddalo, G., Giampalma, E., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Dell'Isola, S., Ialungo, A. M., Roselli, P., Risso, D., Marenco, S., Sammito, G., Bruzzone, L., Bosco, G., Grieco, A., Pompili, M., Rinninella, E., Siciliano, M., Chiaramonte, M., Guarino, M., Camma, C., Maida, M., Di Martino, A., Barcellona, M. R., Schiada, L., Gemini, S., Biasini, E., Porro, E., del Ricambio, M., Mismas, V., and Vivaldi, C.

Subjects
Male, medicine.medical_specialty, Pediatrics, Carcinoma, Hepatocellular, Time Factors, Hepatocellular carcinoma, Settore MED/12 - GASTROENTEROLOGIA, Disease, Gastroenterology, Bias, Internal medicine, Overall survival, medicine, Humans, Early Detection of Cancer, Aged, Estimation, Surveillance, Hepatology, business.industry, Liver Neoplasms, medicine.disease, digestive system diseases, Lead time bias, Cirrhosis, Female, business, Lead-time bias, Follow-Up Studies
Abstract

Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Background & Aims: Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Methods: One-thousand three-hundred and eighty Child–Pugh class A/B patients from the ITA.LI.CA database, in whom HCC was detected during semiannual surveillance (n = 850), annual surveillance (n = 234) or when patients came when symptomatic (n = 296), were selected. Lead-time was estimated by means of appropriate formulas and Monte Carlo simulation, including 1000 patients for each arm. Results: The 5-year overall survival after HCC diagnosis was 32.7% in semiannually surveilled patients, 25.2% in annually surveilled patients, and 12.2% in symptomatic patients (p

Published
2014

7. Resminostat in advanced hepatocellular carcinoma (HCC) : Overall survival subgroup analysis of prognostic factors in the SHELTER trial

Author

Bitzer, M., Ganten, T. M., Woerns, M. A., Siveke, Jens, Dollinger, M. M., Scheulen, Max Ernst, Wege, H., Giannini, E. G., Cillo, U., Trevisani, F., Santoro, A., Montesarchio, V., Mais, A., Hauns, B., Asche, J., Herz, T., Pegoraro, S., Ammendola, A., Henning, S. W., Hentsch, B., and SHELTER Study Grp

Subjects
Oncology, Cancer Research, medicine.medical_specialty, business.industry, Medizin, Subgroup analysis, medicine.disease, chemistry.chemical_compound, Resminostat, chemistry, Hepatocellular carcinoma, Internal medicine, medicine, Overall survival, business
Abstract

e15088 Background: Previously published results of the phase I/II SHELTER study demonstrated efficacy and safety of the novel pan-HDAC inhibitor resminostat in second-line treatment of HCC patients (pts) who had progressed under first-line sorafenib. As patient baseline characteristics might influence treatment outcome, an analysis of their potential influence on overall survival (OS) was performed. Methods: 45 pts with advanced-stage HCC and centrally confirmed radiologic progression under first-line sorafenib were included in a multi-center, two-arm trial. Resminostat was administered either alone or in combination with sorafenib. A Cox proportional-hazards model was used to evaluate the interaction between baseline characteristics and the effect of the two treatment groups on overall survival. Results: In the combination group, pts with Child-Pugh-A, ECOG 0 or absence of vascular invasion had a statistically significant lower risk of death compared to pts with Child-Pugh-B (HR 0.19, 95% CI 0.06-0.55), ECOG 1 (HR 0.15, 95% CI 0.05-0.44), or vascular invasion (HR 0.37, 95% CI 0.15-0.93), respectively. For pts with BCLC-B there was a strong trend, although not statistically significant, of a lower risk of death when compared to pts with BCLC-C (HR 0.43, 95% CI 0.13-1.49). Etiology, prior TACE therapy, extrahepatic spread and interval between first- and second-line treatment had no impact on overall survival in this study. Similar findings were observed in the monotherapy group. Comparing the impact of these baseline characteristics in the combination and monotherapy group, no statistically significant different influence on OS between both treatment groups was observed. Conclusions: Resminostat in combination with sorafenib provides a substantial OS benefit (median OS of 8.1 months) for advanced HCC patients who had developed progressive tumor disease under first-line sorafenib therapy. Subgroup analysis of patient baseline characteristics revealed a significant influence of Child-Pugh index, ECOG classification, and vascular invasion on overall survival, whereas e.g. the interval between first- and second-line treatment had no impact on overall survival. Clinical trial information: NCT00943449.

Published
2013

8. Cost-effectiveness of semi-annual surveillance for hepatocellular carcinoma in cirrhotic patients of the Italian Liver Cancer population

Author

CUCCHETTI, ALESSANDRO, TREVISANI, FRANCO, CESCON, MATTEO, ERCOLANI, GIORGIO, ZOLI, MARCO, PINNA, ANTONIO DANIELE, GRAMENZI, ANNAGIULIA, Farinati F., Poggio P. D., Rapaccini G., Nolfo M. A., Benvegnù L., Borzio F., Giannini E. G., Caturelli E., Chiaramonte M., BERNARDI, MAURO, Buccione D., CARACENI, PAOLO, Domenicali M., Erroi V., Fatti G., Frigerio M., Santi V., Magalotti D., Balsamo C., DI MARCO, MARIACRISTINA, Vavassori E., Gilardoni L., Mattiello M., Alberti A., Gatta A., Gios M., Cazzagon N., Giacomin A., Pozzan C., Sergio A., Vanin V., Giampalma E., Golfieri R., Mosconi C., Renzulli M., Ghittoni G., Roselli P., Bodini G., Corbo M., Savarino V., DOMENICALI, MARCO, Cucchetti A., Trevisani F., Cescon M., Ercolani G., Farinati F., Poggio P.D., Rapaccini G., Nolfo M.A., Benvegnù L., Zoli M., Borzio F., Giannini E.G., Caturelli E., Chiaramonte M., Pinna A.D., Bernardi M., Buccione D., Caraceni P., Domenicali M., Erroi V., Fatti G., Frigerio M., Gramenzi A., Santi V., Magalotti D., Balsamo C., Di Marco M., Vavassori E., Gilardoni L., Mattiello M., Alberti A., Gatta A., Gios M., Cazzagon N., Giacomin A., Pozzan C., Sergio A., Vanin V., Giampalma E., Golfieri R., Mosconi C., Renzulli M., Ghittoni G., Roselli P., Bodini G., Corbo M., and Savarino V.

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cost effectiveness, Cost-Benefit Analysis, medicine.medical_treatment, Population, COST-EFFECTIVENESS ANALYSIS, Liver transplantation, Risk Factors, Internal medicine, SURVEILLANCE, medicine, Humans, HEPATOCELLULAR CARCINOMA, Intensive care medicine, education, Survival rate, CIRRHOSIS, Aged, Aged, 80 and over, education.field_of_study, Hepatology, Relative survival, business.industry, Incidence, Liver Neoplasms, Odds ratio, Middle Aged, Prognosis, medicine.disease, Markov Chains, Survival Rate, Italy, Population Surveillance, Female, business, Liver cancer, Incremental cost-effectiveness ratio
Abstract

BACKGROUND AND AIMS: It was recently shown that semi-annual surveillance for hepatocellular carcinoma (HCC) in cirrhotic patients provides a prognostic advantage over the annual program; however, its cost-effectiveness (CE) in the general cirrhotic population still needs to be defined. METHODS: A Markov model was built to compare CE of these two strategies, considering literature results and treatment modalities of 918 cirrhotic patients from the Italian Liver Cancer (ITA.LI.CA) database. RESULTS: Results from the Markov model suggest that, compared to annual surveillance, semi-annual surveillance leads to a gain in quality-adjusted life expectancy, in an unselected cirrhotic population, of 1.35 quality-adjusted life-months (QALMs) over 10 years since surveillance start in compensated patients, and of 0.73 QALMs in decompensated patients. Semi-annual surveillance was more cost-effective in compensated than in decompensated cirrhosis, with an incremental CE ratio (ICER) of 1997 and 3814€/QALM, respectively. In compensated cirrhosis, semi-annual surveillance was more cost-effective than the annual program when the annual HCC incidence was ≥3.2% and the relative survival gain after cancer diagnosis was ≥20% with respect to the annual program. In decompensated cirrhosis, semi-annual surveillance was cost-effective in patients amenable to liver transplantation. In both groups, CE of semi-annual surveillance improved with the increase of annual incidence and the survival benefit obtainable with HCC treatment. CONCLUSIONS: Both surveillance strategies for HCC in cirrhotic patients can be recommended, according to the individual risk profile for HCC occurrence and the expected survival gain obtainable after tumor diagnosis and therapy.

Published
2012

9. Years of life that could be saved from prevention of hepatocellular carcinoma

Author

Andrea Costantino, Marcello Maida, Fabio Farinati, Laura Schiadà, Stefano Tamberi, Alessandro Moscatelli, Elena Rastrelli, Maria Chiaramonte, Paolo Poggio, Gianluca Svegliati Baroni, Matteo Renzulli, Fabio Piscaglia, Filomena Morisco, Paola Roselli, Roberto Virdone, Anna Maria Lalungo, Matteo Ravaioli, E.G. Giannini, Anna Chiara Dall’Aglio, Antonio Daniele Pinna, Elena Vavassori, Fabiana Marchetti, Eugenio Caturelli, Marco Domenicali, Calogero Cammà, Giulia Bosco, Carla Serra, Claudia Balsamo, Donatella Magalotti, Gian Ludovico Rapaccini, Valeria Mismas, S. Gemini, Stefano Olmi, Alberto Masotto, V. Feletti, Francesca Murer, Gaia Pellegatta, Maria Rosa Barcellona, A. Gazzola, Andrea Mega, Luigi Bolondi, Paolo Caraceni, Laura Bucci, Rita Golfieri, Annagiulia Gramenzi, Francesca Ciccarese, Rodolfo Sacco, Cristina Mosconi, Franco Borzio, Emanuele Rinninella, M. Di Marco, Alberta Cappelli, Marco Zoli, V. Vanin, Luisa Benvegnù, Mauro Bernardi, Emanuela Porro, Matteo Valerio, A. Pecorelli, Antonino Picciotto, Federica Mirici Cappa, Martina Felder, Elisabetta Biasini, Antonio Gasbarrini, Maurizio Biselli, Alessandro Cucchetti, Gabriele Missale, L. Venerandi, Serena Dell'Isola, Franco Trevisani, Elga Neri, Vincenzo Savarino, Maria Guarino, C. Pozzan, Giuseppe Cabibbo, F.G. Foschi, Giuseppe Francesco Stefanini, Arianna Lanzi, Andrea Affronti, Cucchetti, A, Trevisani, F, Bucci, L, Ravaioli, M, Farinati, F, Giannini, E. G, Ciccarese, F, Piscaglia, F, Rapaccini, G. L, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Maida, M, Felder, M, Morisco, Filomena, Gasbarrini, A, Gemini, S, Foschi, F. G, Missale, G, Masotto, A, Affronti, A, Bernardi, M, Pinna, A. D., Giannini, Eg, Rapaccini, Gl, Morisco, F, Foschi, Fg, Pinna, AD, Italian Liver Cancer (ITA.LI.CA.) Group, Bolondi, L, Biselli, M, Caraceni, P, Domenicali, M, Gramenzi, A., Cucchetti, A., Trevisani, F., Bucci, L., Ravaioli, M., Farinati, F., Giannini, E. G., Ciccarese, F., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Maida, M., Felder, M., Morisco, F., Gasbarrini, A., Gemini, S., Foschi, F. G., Missale, G., Masotto, A., Affronti, A., Bernardi, M., Bolondi, L., Biselli, M., Caraceni, P., Domenicali, M., 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., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Bosco, G., Roselli, P., Dell'Isola, S., Lalungo, A. M., Rastrelli, E., Moscatelli, A., Pellegatta, G., Picciotto, A., Savarino, V., Barcellona, M. R., Camma, C., Cabibbo, G., Costantino, A., Virdone, R., Mega, A., Rinninella, E., Mismas, V., Dall'Aglio, A. C., Feletti, V., Lanzi, A., Cappa, F. M., Neri, E., Stefanini, G. F., Tamberi, S., Biasini, E., Porro, E., Guarino, M., Baroni, G. S., Schiada, L., Chiaramonte, M., Marchetti, F., and Valerio, M.

Subjects
Registrie, Male, Pediatrics, Databases, Factual, Hepatocellular carcinoma, 0302 clinical medicine, prevention, 80 and over, Secondary Prevention, Pharmacology (medical), Prospective Studies, Registries, Young adult, Prospective cohort study, Secondary prevention, Aged, 80 and over, education.field_of_study, Liver Neoplasms, Gastroenterology, Disease Management, Middle Aged, Primary Prevention, diagnosi, Italy, Liver Neoplasm, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Human, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Adolescent, Population, life expentancy, Milan criteria, 03 medical and health sciences, Databases, Young Adult, Life Expectancy, medicine, Humans, Aged, education, Factual, Hepatology, business.industry, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Hepatocellular, medicine.disease, Surgery, Prospective Studie, Years of potential life lost, Life expectancy, business
Abstract

Summary Background Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. Aim To assess how many years of life are lost after HCC diagnosis. Methods Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. Results Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18–61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986–1999, to 10.7 in 2000–2006 and 7.4 years in 2007–2014. Currently, an HCC diagnosis when a single tumour

Published
2016

10. Comparison between alcohol- and hepatitis C virus-related hepatocellular carcinoma: clinical presentation, treatment and outcome

Author

BUCCI, LAURA, GARUTI, FRANCESCA, LENZI, BARBARA, PISCAGLIA, FABIO, ZOLI, MARCO, BERNARDI, MAURO, TREVISANI, FRANCO, BOLONDI, LUIGI, BISELLI, MAURIZIO, CARACENI, PAOLO, CUCCHETTI, ALESSANDRO, DOMENICALI, MARCO, GRAMENZI, ANNAGIULIA, Camelli, V, Farinati, F, Giannini, E, Ciccarese, F, Rapaccini, G, Di Marco, M, Caturelli, E, Borzio, F, Sacco, R, Maida, M, Felder, M, Morisco, F, Gasbarrini, A, Gemini, S, Foschi, F, Missale, G, Masotto, A, Affronti, A, Italian Liver Cancer Group, Bucci, L., Garuti, F., Camelli, V., Lenzi, B., Farinati, F., Giannini, E. G., Ciccarese, F., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Maida, M., Felder, M., Morisco, F., Gasbarrini, A., Gemini, S., Foschi, F. G., Missale, G., Masotto, A., Affronti, A., Bernardi, M., Trevisani, F, Olmi, S, on behalf of Italian Liver Cancer, (ITA. LI. CA) Group., Bucci, L, Garuti, F, Camelli, V, Lenzi, B, Farinati, F, Giannini, E, Ciccarese, F, Piscaglia, F, Rapaccini, G, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Maida, M, Felder, M, Morisco, F, Gasbarrini, A, Gemini, S, Foschi, F, Missale, G, Masotto, A, Affronti, A, Bernardi, M, Italian Liver Cancer (ITA.LI.CA.) Group, Bolondi, L, Biselli, M, Caraceni, P, Cucchetti, A, Domenicali, M, Gramenzi, A, Giannini, E. G, Rapaccini, G. L, Morisco, Filomena, Foschi, F. G, and Trevisani, F.

Subjects
Male, Sex Factor, Gastroenterology, Hepatitis, 0302 clinical medicine, alcoholic cirrhosi, Liver Function Tests, Retrospective Studie, Risk Factors, Esophageal and Gastric Varice, 80 and over, Age Factor, Pharmacology (medical), Age Factors, Aged, Aged, 80 and over, Carcinoma, Hepatocellular, Esophageal and Gastric Varices, Female, Hepatitis C, Hepatitis, Alcoholic, Humans, Liver Neoplasms, Middle Aged, Neoplasm Staging, Prognosis, Proportional Hazards Models, Retrospective Studies, Sex Factors, Treatment Outcome, Venous Thrombosis, alpha-Fetoproteins, Medicine (all), medicine.diagnostic_test, Liver Function Test, Alcoholic, Liver Neoplasm, Hepatocellualr carinoma, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, epidemiology, 030211 gastroenterology & hepatology, Liver cancer, Viral hepatitis, Human, medicine.medical_specialty, Prognosi, 03 medical and health sciences, Internal medicine, medicine, Venous Thrombosi, Hepatology, business.industry, Risk Factor, Carcinoma, Cancer, Hepatocellular, medicine.disease, digestive system diseases, BCLC Stage, Proportional Hazards Model, Liver function, business, Liver function tests, HCV-related cirrhosi
Abstract

Summary Background Hepatitis C virus (HCV) and alcohol abuse are the main risk factors for hepatocellular carcinoma (HCC) in Western countries. Aim To investigate the role of alcoholic aetiology on clinical presentation, treatment and outcome of HCC as well as on each Barcelona Clinic Liver Cancer (BCLC) stage, as compared to HCV-related HCCs. Methods A total of 1642 HCV and 573 alcoholic patients from the Italian Liver Cancer (ITA.LI.CA) database, diagnosed with HCC between January 2000 and December 2012 were compared for age, gender, type of diagnosis, tumour burden, portal vein thrombosis (PVT), oesophageal varices, liver function tests, alpha-fetoprotein, BCLC, treatment and survival. Aetiology was tested as predictor of survival in multivariate Cox regression models and according to HCC stages. Results Cirrhosis was present in 96% of cases in both groups. Alcoholic patients were younger, more likely male, with HCC diagnosed outside surveillance, in intermediate/terminal BCLC stage and had worse liver function. After adjustment for the lead-time, median (95% CI) overall survival (OS) was 27.4 months (21.5–33.2) in alcoholic and 33.6 months (30.7–36.5) in HCV patients (P = 0.021). The prognostic role of aetiology disappeared when survival was assessed in each BCLC stage and in the Cox regression multivariate models. Conclusions Alcoholic aetiology affects survival of HCC patients through its negative effects on secondary prevention and cancer presentation but not through a greater cancer aggressiveness or worse treatment result. In fact, survival adjusted for confounding factors was similar in alcoholic and HCV patients.

Published
2015

11. Surveillance for hepatocellular carcinoma with a 3-months interval in 'extremely high-risk' patients does not further improve survival

Author

Filippo Pelizzaro, Giulia Peserico, Marco D'Elia, Nora Cazzagon, Francesco Paolo Russo, Alessandro Vitale, Edoardo G. Giannini, Manuela Piccinnu, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Giuseppe Cabibbo, Fabio Marra, Andrea Mega, Filomena Morisco, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Andrea Olivani, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Filippo Oliveri, Franco Trevisani, Fabio Farinati, Maurizio Biselli, Paolo Caraceni, Francesca Garuti, Annagiulia Gramenzi, Andrea Neri, Valentina Santi, Fabio Piscaglia, Francesco Tovoli, Alessandro Granito, Luca Muratori, Francesca Benevento, Elton Dajti, Giovanni Marasco, Federico Ravaioli, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Angela Imondi, Anna Sartori, Barbara Penzo, Elisa Pinto, Ester Marina Cela, Antonio Facciorusso, Valentina Cacciato, Edoardo Casagrande, Alessandro Moscatelli, Gaia Pellegatta, Nicoletta De Matthaeis, Gloria Allegrini, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Gabriele Missale, Alessandro Inno, Fabiana Marchetti, Anita Busacca, Calogero Cammà, Vincenzo Di Martino, Giacomo Emanuele Maria Rizzo, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Anna Chiara Dall'aglio, Giorgio Ercolani, Federica Mirici, Claudia Campani, Chiara Di Bonaventura, Stefano Gitto, Pietro Coccoli, Antonio Malerba, Maria Guarino, Maurizia Brunetto, Veronica Romagnoli, Pelizzaro, F., Peserico, G., D'Elia, M., Cazzagon, N., Russo, F. P., Vitale, A., Giannini, E. G., Piccinnu, M., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Marra, F., Mega, A., Morisco, F., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Olivani, A., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Farinati, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Santi, V., Piscaglia, F., Tovoli, F., Granito, A., Muratori, L., Benevento, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Imondi, A., Sartori, A., Penzo, B., Pinto, E., Cela, E. M., Facciorusso, A., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., De Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Missale, G., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Casadei Gardini, A., Conti, F., Dall'Aglio, A. C., Ercolani, G., Mirici, F., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Guarino, M., Brunetto, M., Romagnoli, V., Pelizzaro, Filippo, Peserico, Giulia, D'Elia, Marco, Cazzagon, Nora, Russo, Francesco Paolo, Vitale, Alessandro, Giannini, Edoardo G., Piccinnu, Manuela, Rapaccini, Gian Ludovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Sacco, Rodolfo, Cabibbo, Giuseppe, Marra, Fabio, Mega, Andrea, Morisco, Filomena, Gasbarrini, Antonio, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Raimondo, Giovanni, Azzaroli, Francesco, Vidili, Gianpaolo, Oliveri, Filippo, Trevisani, Franco, Farinati, Fabio, Biselli, Maurizio, Caraceni, Paolo, Garuti, Francesca, Gramenzi, Annagiulia, Neri, Andrea, Santi, Valentina, Piscaglia, Fabio, Tovoli, Francesco, Granito, Alessandro, Muratori, Luca, Benevento, Francesca, Dajti, Elton, Marasco, Giovanni, Ravaioli, Federico, Cappelli, Alberta, Golfieri, Rita, Mosconi, Cristina, Renzulli, Matteo, Imondi, Angela, Sartori, Anna, Penzo, Barbara, Pinto, Elisa, Cela, Ester Marina, Facciorusso, Antonio, Cacciato, Valentina, Casagrande, Edoardo, Moscatelli, Alessandro, Pellegatta, Gaia, De Matthaeis, Nicoletta, Allegrini, Gloria, Lauria, Valentina, Ghittoni, Giorgia, Pelecca, Giorgio, Chegai, Fabrizio, Coratella, Fabio, Ortenzi, Mariano, Missale, Gabriele, Inno, Alessandro, Marchetti, Fabiana, Busacca, Anita, Cammà, Calogero, Di Martino, Vincenzo, Rizzo, Giacomo Emanuele Maria, Franzè, Maria Stella, Saitta, Carlo, Sauchella, Assunta, Bevilacqua, Vittoria, Borghi, Alberto, Casadei Gardini, Andrea, Conti, Fabio, Dall'aglio, Anna Chiara, Ercolani, Giorgio, Mirici, Federica, Campani, Claudia, Di Bonaventura, Chiara, Gitto, Stefano, Coccoli, Pietro, Malerba, Antonio, Guarino, Maria, Brunetto, Maurizia, and Romagnoli, Veronica

Subjects
medicine.medical_specialty, Carcinoma, Hepatocellular, Survival, Hepatocellular carcinoma, Cancer stage, Surveillance interval, Internal medicine, medicine, Humans, Propensity Score, Survival analysis, High risk patients, Hepatology, business.industry, Liver Neoplasms, Settore MED/09 - MEDICINA INTERNA, Gastroenterology, Patient survival, medicine.disease, Survival Analysis, Propensity score matching, Survival Analysi, Liver cancer, business, Median survival, Human
Abstract

Background An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.

Published
2022

12. Overview of Prognostic Systems for Hepatocellular Carcinoma and ITA.LI.CA External Validation of MESH and CNLC Classifications

Author

Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, Eg, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, Gg, Di Sandro, S, Famularo, S, Foschi, Fg, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, Gv, Losito, F, Lupo, Lg, Marasco, G, Manzia, Tm, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, Fr, Pravisani, R, Rapaccini, Gl, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, Fp, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, Mr, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E.G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G.G., Di Sandro S., Famularo S., Foschi F.G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G.V., Losito F., Lupo L.G., Marasco G., Manzia T.M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F.R., Pravisani R., Rapaccini G.L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F.P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M.R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., Zoli M., Vitale, A., Farinati, F., Finotti, M., Di Renzo, C., Brancaccio, G., Piscaglia, F., Cabibbo, G., Caturelli, E., Missale, G., Marra, F., Sacco, R., Giannini, E. G., Trevisani, F., Cillo, U., Bhoori, S., Borzio, M., Burra, P., Casadei Gardini, A., Carrai, P., Conti, F., Cozzolongo, R., Cucchetti, A., D'Ambrosio, R., Dell'Unto, C., De Matthaeis, N., Di Costanzo, G. G., Di Sandro, S., Famularo, S., Foschi, F. G., Fucilli, F., Galati, G., Gambato, M., Gasbarrini, A., Giuliante, F., Ghinolfi, D., Grieco, A., Gruttadauria, S., Guarino, M., Iavarone, M., Kostandini, A., Lai, Q., Lenci, I., Levi Sandri, G. V., Losito, F., Lupo, L. G., Marasco, G., Manzia, T. M., Mazzocato, S., Masarone, M., Melandro, F., Mescoli, C., Miele, L., Morisco, F., Muley, M., Nicolini, D., Pagano, D., Persico, M., Pompili, M., Ponziani, F. R., Pravisani, R., Rapaccini, G. L., Rendina, M., Renzulli, M., Romano, F., Rossi, M., Rreka, E., Russo, F. P., Sangiovanni, A., Sessa, A., Simonetti, N., Sposito, C., Tortora, R., Vigano, L., Vigano, M., Villa, E., Vincenzi, V., Violi, P., Azzaroli, F., Brunetto, M. R., Di Marco, A., Masotto, A., Mega, A., Nardone, G., Oliveri, F., Raimondo, G., Svegliati Baroni, G., Vidili, G., and Zoli, M.

Subjects
Cancer Research, medicine.medical_specialty, Review, lcsh:RC254-282, Prognostic score, 03 medical and health sciences, 0302 clinical medicine, medicine, In patient, Medical physics, Staging system, monotonicity of gradients, Settore MED/12 - Gastroenterologia, discrimination ability, hepatocellular carcinoma, homogeneity, prognostic performance, prognostic system, business.industry, External validation, Mono-tonicity of gradient, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Settore MED/18, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Population data, 030211 gastroenterology & hepatology, General health, Liver dysfunction, business
Abstract

Simple Summary This review proposes a comprehensive overview of the main prognostic systems for HCC classified as prognostic scores, staging systems, or combined systems. Prognostic systems for HCC are usually compared in terms of homogeneity, monotonicity of gradients, and discrimination ability. However, despite the great number of published studies comparing HCC prognostic systems, it is rather difficult to identify a system that could be universally accepted as the best prognostic scheme for all HCC patients encountered in clinical practice. In order to give a contribute in this topic, we conducted a study aimed at externally validate the MESH score and the CNLC classification using the ITA.LI.CA database. Abstract Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.

Published
2021

13. Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

Author

Giovanni Raimondo, Alberto Masotto, Edoardo G. Giannini, Filippo Oliveri, Fabio Piscaglia, Francesco Giuseppe Foschi, Giuseppe Cabibbo, Gianpaolo Vidili, Francesco Azzaroli, Gian Ludovico Rapaccini, Antonio Gasbarrini, Rodolfo Sacco, Franco Trevisani, Gerardo Nardone, Maria Di Marco, Fabio Marra, Brian I. Carr, Eugenio Caturelli, Andrea Mega, Marco Zoli, Filomena Morisco, Vito Guerra, Gianluca Svegliati-Baroni, Fabio Farinati, Gabriele Missale, Rossella Donghia, Carr B.I., Guerra V., Donghia R., Farinati F., Giannini E.G., Piscaglia F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Cabibbo G., Marra F., Mega A., Morisco F., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Missale G., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Oliveri F., Trevisani F., Carr, B. I., Guerra, V., Donghia, R., Farinati, F., Giannini, E. G., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Marra, F., Mega, A., Morisco, F., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., and Trevisani, F.

Subjects
Male, Cancer Research, Pathology, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Settore MED/12 - GASTROENTEROLOGIA, Clinical Biochemistry, size, Pathology and Forensic Medicine, evolution, medicine, Humans, Prospective Studies, HCC, Tumor size, business.industry, Liver Neoplasms, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Hepatocellular, Middle Aged, Prognosis, medicine.disease, Portal vein thrombosis, trend, Oncology, Liver Neoplasm, Hepatocellular carcinoma, Female, business, Human
Abstract

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( PConclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.

Published
2021

14. Identification of clinical phenotypes and related survival in patients with large hccs

Author

Rossella Donghia, Antonio Gasbarrini, Giovanni Raimondo, Elisabetta Biasini, Francesco Giuseppe Foschi, Gianpaolo Vidili, Maria Guarino, Andrea Mega, Marco Zoli, Rodolfo Sacco, Fabio Farinati, Brian I. Carr, Gianluca Svegliati-Baroni, Ciro Celsa, Eugenio Caturelli, Edoardo G. Giannini, Vito Guerra, Gian Ludovico Rapaccini, Maria Di Marco, Gerardo Nardone, Franco Trevisani, Claudia Campani, Luca Muratori, Francesco Azzaroli, Maurizia Rossana Brunetto, Alberto Masotto, Carr B.I., Guerra V., Donghia R., Farinati F., Giannini E.G., Muratori L., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Celsa C., Campani C., Mega A., Guarino M., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Biasini E., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Brunetto M.R., Trevisani F., Carr, B. I., Guerra, V., Donghia, R., Farinati, F., Giannini, E. G., Muratori, L., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Celsa, C., Campani, C., Mega, A., Guarino, M., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Brunetto, M. R., and Trevisani, F.

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, PVT, Settore MED/12 - GASTROENTEROLOGIA, Serum albumin, lcsh:RC254-282, Gastroenterology, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Platelet, HCC, neoplasms, Survival rate, biology, business.industry, Proportional hazards model, Albumin, Hazard ratio, Settore MED/09 - MEDICINA INTERNA, Multifocality, large, phenotypes, multifocality, albumin, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, digestive system diseases, Portal vein thrombosis, Large, Phenotypes, Phenotype, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, biology.protein, business
Abstract

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin &gt, 3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (&lt, 100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.

Published
2021

15. Comparison of prognostic models in advanced hepatocellular carcinoma patients undergoing Sorafenib: A multicenter study

Author

Marasco, G, Colecchia, A, Bacchi Reggiani ML, Celsa, C, Farinati, F, Giannini, Eg, Benevento, F, Rapaccini, Gl, Caturelli, E, Di Marco, M, Biasini, E, Marra, F, Morisco, F, Foschi, Fg, Zoli, M, Gasbarrini, A, Baroni, Gs, Masotto, A, Sacco, R, Raimondo, G, Azzaroli, F, Mega, A, Vidili, G, Brunetto, Mr, Nardone, G, Dajti, E, Ravaioli, F, Avanzato, F, Festi, D, Trevisani, F, group, Italian Liver Cancer (ITA. LI. CA., Marasco G., Colecchia A., Bacchi Reggiani M.L., Celsa C., Farinati F., Giannini E.G., Benevento F., Rapaccini G.L., Caturelli E., Di Marco M., Biasini E., Marra F., Morisco F., Foschi F.G., Zoli M., Gasbarrini A., Baroni G.S., Masotto A., Sacco R., Raimondo G., Azzaroli F., Mega A., Vidili G., Brunetto M.R., Nardone G., Dajti E., Ravaioli F., Avanzato F., Festi D., Trevisani F., Marasco, G., Colecchia, A., Bacchi Reggiani, M. L., Celsa, C., Farinati, F., Giannini, E. G., Benevento, F., Rapaccini, G. L., Caturelli, E., Di Marco, M., Biasini, E., Marra, F., Morisco, F., Foschi, F. G., Zoli, M., Gasbarrini, A., Baroni, G. S., Masotto, A., Sacco, R., Raimondo, G., Azzaroli, F., Mega, A., Vidili, G., Brunetto, M. R., Nardone, G., Dajti, E., Ravaioli, F., Avanzato, F., Festi, D., and Trevisani, F.

Subjects
Oncology, Male, Survival, Hepatocellular carcinoma, Cohort study, Hepatocellular carcinoma, Prognosis, Sorafenib, Survival, Severity of Illness Index, Antineoplastic Agent, 0302 clinical medicine, Prospective Studies, Liver Neoplasms, Gastroenterology, Middle Aged, Sorafenib, Prognosis, Treatment Outcome, Italy, Liver Neoplasm, 030220 oncology & carcinogenesis, Cohort, 030211 gastroenterology & hepatology, Female, Liver cancer, Cohort study, medicine.drug, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Settore MED/12 - GASTROENTEROLOGIA, Antineoplastic Agents, Risk Assessment, 03 medical and health sciences, Internal medicine, medicine, Humans, neoplasms, Prognostic models, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Hepatology, business.industry, Settore MED/09 - MEDICINA INTERNA, Gold standard, medicine.disease, digestive system diseases, Multicenter study, business
Abstract

Background: Sorafenib is the gold standard therapy for the advanced hepatocellular carcinoma (HCC). No scoring/staging is universally accepted to predict the survival of these patients. Aims: To evaluate the accuracy of the available prognostic models for HCC to predict the survival of advanced HCC patients treated with Sorafenib included in the Italian Liver Cancer (ITA.LI.CA.) multicenter cohort. Methods: The performance of several prognostic scores was assessed through a Cox regression-model evaluating the C-index and the Akaike Information Criterion (AIC). Results: Data of 1129 patients were analyzed. The mean age of patients was 61.6 years, and 80.8% were male. During a median follow-up period of 13 months, 789 patients died. The median period of Sorafenib administration was 4 months. All the prognostic scores were able to predict the overall survival (p

Published
2021

16. Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Author

Francesco Giuseppe Foschi, Gianpaolo Vidili, Andrea Mega, Antonio Gasbarrini, Marco Zoli, Edoardo G. Giannini, Rodolfo Sacco, Alessandro Vitale, Francesco Tovoli, Giacomo Laffi, Maria Di Marco, Giovanni Raimondo, Gianluca Svegliati-Baroni, Claudia Campani, Francesco Azzaroli, Fabio Farinati, Umberto Arena, Fabio Marra, Gabriele Dragoni, Alberto Masotto, Franco Trevisani, Maurizia Rossana Brunetto, Giuseppe Cabibbo, Elisabetta Biasini, Gian Ludovico Rapaccini, Eugenio Caturelli, Gerardo Nardone, Maria Guarino, Umberto Cillo, Campani, C., Vitale, A., Dragoni, G., Arena, U., Laffi, G., Cillo, U., Giannini, E. G., Tovoli, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Mega, A., Guarino, M., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Biasini, E., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Brunetto, M. R., Farinati, F., Trevisani, F., Marra, F., Campani C., Vitale A., Dragoni G., Arena U., Laffi G., Cillo U., Giannini E.G., Tovoli F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Sacco R., Cabibbo G., Mega A., Guarino M., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Biasini E., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Brunetto M.R., Farinati F., Trevisani F., and Marra F.

Subjects
ALBI grade, Barcelona Clinic Liver Cancer, Cancer of the Liver Italian Program, ITALICA staging system, MESIAH, medicine.medical_specialty, lcsh:RC254-282, Gastroenterology, Internal medicine, Medicine, In patient, Radiologic Response, Settore MED/12 - Gastroenterologia, Original Paper, Hepatology, business.industry, Proportional hazards model, Confounding, Hazard ratio, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Oncology, Hepatocellular carcinoma, Akaike information criterion, business, Liver cancer
Abstract

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

Published
2021

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

Author

Antonio Colecchia, Antonio Gasbarrini, Francesco Giuseppe Foschi, Alessandro Vitale, Luisa Benvegnù, Gerardo Nardone, Gabriele Missale, Timothy M. Pawlik, Fabio Farinati, Umberto Cillo, Rodolfo Sacco, Edoardo G. Giannini, Gianluca Svegliati-Baroni, Filomena Morisco, Mauro Bernardi, Anna Chiara Frigo, Lucia Napoli, Marco Zoli, Franco Trevisani, Franco Borzio, Martina Felder, Gian Ludovico Rapaccini, Eugenio Caturelli, Maria Di Marco, Fabio Marra, Giuseppe Cabibbo, Alberto Masotto, Francesco Ciccarese, Roberto Virdone, Vitale A., Farinati F., Pawlik T.M., Frigo A.C., Giannini E.G., Napoli L., Ciccarese F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Borzio F., Sacco R., Cabibbo G., Virdone R., Marra F., Felder M., Morisco F., Benvegnu L., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Missale G., Masotto A., Nardone G., Colecchia A., Bernardi M., Trevisani F., Cillo U., Vitale, A., Farinati, F., Pawlik, T. M., Frigo, A. C., Giannini, E. G., Napoli, L., Ciccarese, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Cabibbo, G., Virdone, R., Marra, F., Felder, M., Morisco, F., Benvegnu, L., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Colecchia, A., Bernardi, M., Trevisani, F., and Cillo, U.

Subjects
Male, Oncology, Sorafenib, medicine.medical_specialty, Prognostic variable, Carcinoma, Hepatocellular, medicine.medical_treatment, treatment selection, Liver transplantation, hepatocellular carcinoma, prognostic variable, survival benefit, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, Hepatology, Performance status, business.industry, Liver Neoplasms, Hazard ratio, Middle Aged, medicine.disease, Confidence interval, Italy, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Female, 030211 gastroenterology & hepatology, Liver cancer, business, medicine.drug
Abstract

Background: 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 IPTW-adjusted 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-adjusted multivariate survival model, treatment strategy was found to be the strongest survival predictor, irrespective of ITA.LI.CA prognostic variables and treatment period. The survival benefit of different therapies over BSC was: LT=0.19 (0.18-0.20); RES=0.40 (0.37-0.42); ABL 0.42 (0.40-0.44); IAT=0.58 (0.55-0.61); SOR=0.92 (0.87-0.97). This multivariate model was then used to predict median survival for each therapy within each ITA.LI.CA stage. Conclusion: The concept of therapeutic hierarchy was established within each ITA.LI.CA stage.

Published
2019

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

Author

Pecorelli A, Lenzi B, Gramenzi A, Garuti F, Farinati F, Giannini EG, Ciccarese F, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Felder M, Morisco F, Gasbarrini A, Baroni GS, Foschi FG, Biasini E, Masotto A, Virdone R, Bernardi M, Trevisani F, Bolondi L, Biselli M, Bucci L, Caraceni P, Cucchetti A, Domenicali M, Venerandi L, Giacomin A, Maddalo G, Pozzan C, Vani V, Poggio PD, Olmi S, Balsamo C, Vavassori E, Benvegnù L, Cappelli A, Golfieri R, Mosconi C, Renzulli M, Bosco G, Roselli P, Dell'Isola S, Ialungo AM, Bruzzone L, Picciotto A, Marenco S, Risso D, Sammito G, Savarino V, Cammà C, Maida M, Costantino A, Barcellona MR, Affronti A, Mega A, Rinninella E, Mismas V, Cappa FM, Dall'Aglio AC, Feletti V, Lanzi A, Neri E, Stefanini GF, Tamberi S, Missale G, Porro E, Guarino M, Gemini S, Schiadà L, for the Italian LiverCancer (ITA. LI. CA) group, Donatella Magalotti, Carla Serra, Pecorelli A, Lenzi B, Gramenzi A, Garuti F, Farinati F, Giannini EG, Ciccarese F, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Felder M, Morisco F, Gasbarrini A, Baroni GS, Foschi FG, Biasini E, Masotto A, Virdone R, Bernardi M, Trevisani F, Bolondi L, Biselli M, Bucci L, Caraceni P, Cucchetti A, Domenicali M, Magalotti D, Serra C, Venerandi L, Giacomin A, Maddalo G, Pozzan C, Vani V, Poggio PD, Olmi S, Balsamo C, Vavassori E, Benvegnù L, Cappelli A, Golfieri R, Mosconi C, Renzulli M, Bosco G, Roselli P, Dell'Isola S, Ialungo AM, Bruzzone L, Picciotto A, Marenco S, Risso D, Sammito G, Savarino V, Cammà C, Maida M, Costantino A, Barcellona MR, Affronti A, Mega A, Rinninella E, Mismas V, Cappa FM, Dall'Aglio AC, Feletti V, Lanzi A, Neri E, Stefanini GF, Tamberi S, Missale G, Porro E, Guarino M, Gemini S, Schiadà L, Pecorelli, A., Lenzi, B., Gramenzi, A., Garuti, F., Farinati, F., Giannini, E. G., Ciccarese, F., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Cabibbo, G., Felder, M., Morisco, F., Gasbarrini, A., Baroni, G. S., Foschi, F. G., Biasini, E., Masotto, A., Virdone, R., Bernardi, M., Trevisani, F., Bolondi, L., Biselli, M., Bucci, L., Caraceni, P., Cucchetti, A., Domenicali, M., Magalotti, D., Serra, C., Venerandi, L., Giacomin, A., Maddalo, G., Pozzan, C., Vani, V., Poggio, P. D., Olmi, S., Balsamo, C., Vavassori, E., Benvegnu, L., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Bosco, G., Roselli, P., Dell'Isola, S., Ialungo, A. M., Bruzzone, L., Picciotto, A., Marenco, S., Risso, D., Sammito, G., Savarino, V., Camma, C., Maida, M., Costantino, A., Barcellona, M. R., Affronti, A., Mega, A., Rinninella, E., Mismas, V., Cappa, F. M., Dall'Aglio, A. C., Feletti, V., Lanzi, A., Neri, E., Stefanini, G. F., Tamberi, S., Missale, G., Porro, E., Guarino, M., Gemini, S., Schiada, L., Pecorelli, Anna, Lenzi, Barbara, Gramenzi, Annagiulia, Garuti, Francesca, Farinati, Fabio, Giannini, Edoardo G, Ciccarese, Francesca, Piscaglia, Fabio, Rapaccini, Gian Lodovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Sacco, Rodolfo, Cabibbo, Giuseppe, Felder, Martina, Morisco, Filomena, Gasbarrini, Antonio, Baroni, Gianluca Svegliati, Foschi, Francesco G, Biasini, Elisabetta, Masotto, Alberto, Virdone, Roberto, Bernardi, Mauro, and Trevisani, Franco

Subjects
Sorafenib, Male, Niacinamide, medicine.medical_specialty, Standard of care, Carcinoma, Hepatocellular, Antineoplastic Agents, Gastroenterology, Intermediate stage, 03 medical and health sciences, 0302 clinical medicine, HCC, BCLC-B, Treatment, Hepatology, Internal medicine, medicine, Humans, Chemoembolization, Therapeutic, Propensity Score, Aged, Neoplasm Staging, Retrospective Studies, intermediate stage, treatment, business.industry, Patient Selection, Phenylurea Compounds, Liver Neoplasms, Settore MED/09 - MEDICINA INTERNA, Standard of Care, Middle Aged, medicine.disease, Survival Analysis, Treatment Outcome, Italy, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Propensity score matching, Multivariate Analysis, 030211 gastroenterology & hepatology, Female, Liver function, Liver cancer, business, medicine.drug
Abstract

Background and aims the Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumor burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. Methods retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naive HCC after 1999. Patients were stratified by treatment. Results 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (p

Published
2017

19. Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study

Author

Vitale A, Burra P, Frigo AC, Farinati F, Spolverato G, Volk M, Giannini EG, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, 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 group, TREVISANI, FRANCO, PISCAGLIA, FABIO, ZOLI, MARCO, BERNARDI, MAURO, BOLONDI, LUIGI, BISELLI, MAURIZIO, CARACENI, PAOLO, CUCCHETTI, ALESSANDRO, DOMENICALI, MARCO, GRAMENZI, ANNAGIULIA, 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, Olmi, S, on behalf of Italian Liver Cancer, (ITA. LI. CA) group., Vitale, Alessandro, Burra, Patrizia, Frigo, Anna Chiara, Trevisani, Franco, Farinati, Fabio, Spolverato, Gaya, Volk, Michael, Giannini, Edoardo G, Ciccarese, Francesca, Piscaglia, Fabio, Rapaccini, Gian Lodovico, Di Marco, Mariella, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Cabibbo, Giuseppe, Felder, Martina, Gasbarrini, Antonio, Sacco, Rodolfo, Foschi, Francesco Giuseppe, Missale, Gabriele, Morisco, Filomena, Svegliati Baroni, Gianluca, Virdone, Roberto, Cillo, Umberto, Guarino, Maria, 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, and Gramenzi A

Subjects
Male, medicine.medical_specialty, Cirrhosis, Carcinoma, Hepatocellular, Loco-regional therapie, Hepatocellular carcinoma, Settore MED/12 - GASTROENTEROLOGIA, Hepatitis C virus, Kaplan-Meier Estimate, medicine.disease_cause, Gastroenterology, Cohort Studies, Liver disease, Interquartile range, Internal medicine, medicine, Humans, Best supportive care, Liver resection, Loco-regional therapies, Survival benefit, Aged, Female, Italy, Liver Neoplasms, Middle Aged, Multivariate Analysis, Neoplasm Staging, Prognosis, Treatment Outcome, Medicine (all), Hepatology, BEST SUPPORTING CARE, Cirrhosi, Performance status, business.industry, CIRRHOISIS, Carcinoma, Hepatocellular, medicine.disease, BCLC Stage, Liver cancer, business
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 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.

Published
2014

20. Influence of clinically significant portal hypertension on survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients

Author

Edoardo G. Giannini, Vincenzo Savarino, Fabio Farinati, Francesca Ciccarese, Gianludovico Rapaccini, Mariella Di Marco, Luisa Benvegnu, Franco Borzio, Eugenio Caturelli, Maria Chiaramonte, The Italian Liver Cancer group [. . ., Virginia Erroi, Donatella Magalotti, Sabina Olmi, Emanuela Giampalma, Rita Golfieri, DOMENICALI, MARCO, ZOLI, MARCO, TREVISANI, FRANCO, BERNARDI, MAURO, BISELLI, MAURIZIO, CASSINI, ROMINA, CARACENI, PAOLO, CUCCHETTI, ALESSANDRO, GRAMENZI, ANNAGIULIA, RAVAIOLI, MATTEO, BALSAMO, CLAUDIA, MOSCONI, CRISTINA, RENZULLI, MATTEO, ROSELLI, PAMELA, RISSO, DAVIDE, BOSCO, GIOVANNA, Edoardo G. Giannini, Vincenzo Savarino, Fabio Farinati, Francesca Ciccarese, Gianludovico Rapaccini, Mariella Di Marco, Luisa Benvegnu, Marco Zoli, Franco Borzio, Eugenio Caturelli, Maria Chiaramonte, Franco Trevisani, The Italian Liver Cancer (ITA.LI.CA) group [.., Mauro Bernardi, Maurizio Biselli, Romina Cassini, Paolo Caraceni, Alessandro Cucchetti, Virginia Erroi, Annagiulia Gramenzi, Donatella Magalotti, Matteo Ravaioli, Sabina Olmi, Claudia Balsamo, Emanuela Giampalma, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Pamela Roselli, Davide Risso, Giovanna Bosco, ]., Giannini, E. G., Savarino, V., Farinati, F., Ciccarese, F., Rapaccini, G., Marco, M. D., Benvegnu, L., Zoli, M., Borzio, F., Caturelli, E., Chiaramonte, M., Trevisani, F, Olmi, S, and on behalf of Italian Liver Cancer, (ITA. LI. CA) group.

Subjects
Thrombocytopaenia, Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, Survival, Hepatocellular carcinoma, Hepatic resection, Portal venous pressure, Hepatic venous pressure gradient, Portal hypertensive gastropathy, hepatic resection, Gastroenterology, Internal medicine, Hypertension, Portal, Hepatectomy, Humans, Medicine, HEPATOCELLULAR CARCINOMA, Portal hypertension, Aged, Retrospective Studies, Hepatology, Platelet Count, business.industry, Liver Neoplasms, portal hypertension, Middle Aged, Gastric varices, Prognosis, medicine.disease, Survival Analysis, digestive system diseases, Oesophageal varices, Italy, Surgery, Female, business, Liver cancer
Abstract

Background: The role of clinically significant portal hypertension on the prognosis of cirrhotic patients undergoing hepatic resection for hepatocellular carcinoma (HCC) is debated. Aims: In this study, our aim was to assess the role of clinically significant portal hypertension after hepatic resection for HCC in patients with cirrhosis. Methods: We assessed the prognostic role of the presence of clinically significant portal hypertension (oesophageal/gastric varices/portal hypertensive gastropathy or a platelet count 100 vs 86 months, P = 0.742). Conclusions: Presence of clinically significant portal hypertension has no influence on survival of patients with well-compensated cirrhosis undergoing hepatic resection for HCC. © 2013 John Wiley & Sons A/S.

Published
2013

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