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1. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, S, Donadon, M, Cipriani, F, Bernasconi, D, Labarba, G, Dominioni, T, Iaria, M, Molfino, S, Conci, S, Ferrari, C, Garatti, M, Delvecchio, A, Troci, A, Patauner, S, Frassani, S, Cosimelli, M, Zanus, G, Giuliante, F, Jovine, E, Valsecchi, M, Grazi, G, Antonucci, A, Frena, A, Crespi, M, Memeo, R, Zimmitti, G, Griseri, G, Ruzzenente, A, Baiocchi, G, Dallavalle, R, Maestri, M, Ercolani, G, Aldrighetti, L, Torzilli, G, Romano, F, Ciulli, C, Giani, A, Carissimi, F, Costa, G, Ratti, F, Cucchetti, A, Calabrese, F, Cremaschi, E, Lazzari, G, Franceschi, A, Sega, V, Conticchio, M, Pennacchi, L, Ciola, M, Sciannamea, I, De Peppo, V, Famularo S., Donadon M., Cipriani F., Bernasconi D. P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M. G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., and De Peppo V.

Abstract

Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001). Conclusion: Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

2. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Carissimi, F, Perri, P, Iaria, M, Dominioni, T, Zanello, M, Conci, S, Molfino, S, Labarba, G, Ferrari, C, Germani, P, Patauner, S, Pinotti, E, Lodo, E, Garatti, M, Sciannamea, I, Troci, A, Conticchio, M, Floridi, A, Chiarelli, M, Fumagalli, L, Memeo, R, Crespi, M, Antonucci, A, Zimmitti, G, Zanus, G, Zago, M, Frena, A, Tarchi, P, Griseri, G, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, Ciulli, C, Giani, A, Costa, G, Ratti, F, Bellobono, M, Calabrese, F, Cremaschi, E, De Peppo, V, Cucchetti, A, Lazzari, G, Percivale, A, Ciola, M, Sega, V, Frassani, S, Del Vecchio, A, Pennacchi, L, Corleone, P, Cosola, D, Salvador, L, Montuori, M, Famularo S., Donadon M., Cipriani F., Ardito F., Carissimi F., Perri P., Iaria M., Dominioni T., Zanello M., Conci S., Molfino S., LaBarba G., Ferrari C., Germani P., Patauner S., Pinotti E., Lodo E., Garatti M., Sciannamea I., Troci A., Conticchio M., Floridi A., Chiarelli M., Fumagalli L., Memeo R., Crespi M., Antonucci A., Zimmitti G., Zanus G., Zago M., Frena A., Tarchi P., Griseri G., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., DallaValle R., Grazi G. L., Giuliante F., Aldrighetti L., Torzilli G., Romano F., Bernasconi D. P., Ciulli C., Giani A., Costa G., Ratti F., Bellobono M., Calabrese F., Cremaschi E., De Peppo V., Cucchetti A., Lazzari G., Percivale A., Ciola M., Sega V., Frassani S., Del Vecchio A., Pennacchi L., Corleone P., Cosola D., Salvador L., Montuori M., Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Carissimi, F, Perri, P, Iaria, M, Dominioni, T, Zanello, M, Conci, S, Molfino, S, Labarba, G, Ferrari, C, Germani, P, Patauner, S, Pinotti, E, Lodo, E, Garatti, M, Sciannamea, I, Troci, A, Conticchio, M, Floridi, A, Chiarelli, M, Fumagalli, L, Memeo, R, Crespi, M, Antonucci, A, Zimmitti, G, Zanus, G, Zago, M, Frena, A, Tarchi, P, Griseri, G, Ercolani, G, Baiocchi, G, Ruzzenente, A, Jovine, E, Maestri, M, Dallavalle, R, Grazi, G, Giuliante, F, Aldrighetti, L, Torzilli, G, Romano, F, Bernasconi, D, Ciulli, C, Giani, A, Costa, G, Ratti, F, Bellobono, M, Calabrese, F, Cremaschi, E, De Peppo, V, Cucchetti, A, Lazzari, G, Percivale, A, Ciola, M, Sega, V, Frassani, S, Del Vecchio, A, Pennacchi, L, Corleone, P, Cosola, D, Salvador, L, Montuori, M, Famularo S., Donadon M., Cipriani F., Ardito F., Carissimi F., Perri P., Iaria M., Dominioni T., Zanello M., Conci S., Molfino S., LaBarba G., Ferrari C., Germani P., Patauner S., Pinotti E., Lodo E., Garatti M., Sciannamea I., Troci A., Conticchio M., Floridi A., Chiarelli M., Fumagalli L., Memeo R., Crespi M., Antonucci A., Zimmitti G., Zanus G., Zago M., Frena A., Tarchi P., Griseri G., Ercolani G., Baiocchi G. L., Ruzzenente A., Jovine E., Maestri M., DallaValle R., Grazi G. L., Giuliante F., Aldrighetti L., Torzilli G., Romano F., Bernasconi D. P., Ciulli C., Giani A., Costa G., Ratti F., Bellobono M., Calabrese F., Cremaschi E., De Peppo V., Cucchetti A., Lazzari G., Percivale A., Ciola M., Sega V., Frassani S., Del Vecchio A., Pennacchi L., Corleone P., Cosola D., Salvador L., and Montuori M.

Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

3. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience

Author

Famularo, S., Donadon, M., Cipriani, Fabrizio, Ardito, Francesco, Carissimi, F., Perri, Pierluigi, Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, Anna Maria, Zimmitti, Giuseppe, Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, Marta, Dallavalle, R., Grazi, G. L., Giuliante, Felice, Aldrighetti, L., Torzilli, Guido, Romano, Federica, Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, Giovanni, Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, Arianna, Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., Montuori, M., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Ardito, Francesco, Carissimi, Francesca, Perri, Pasquale, Iaria, Maurizio, Dominioni, Tommaso, Zanello, Matteo, Conci, Simone, Molfino, Sarah, LaBarba, Giuliano, Ferrari, Cecilia, Germani, Paola, Patauner, Stefan, Pinotti, Enrico, Lodo, Enrico, Garatti, Marco, Sciannamea, Ivano, Troci, Albert, Conticchio, Maria, Floridi, Antonio, Chiarelli, Marco, Fumagalli, Luca, Memeo, Riccardo, Crespi, Michele, Antonucci, Adelmo, Zimmitti, Giuseppe, Zanus, Giacomo, Zago, Mauro, Frena, Antonio, Tarchi, Paola, Griseri, Guido, Ercolani, Giorgio, Baiocchi, Gian Luca, Ruzzenente, Andrea, Jovine, Elio, Maestri, Marcello, DallaValle, Raffaele, Grazi, Gian Luca, Giuliante, Felice, Aldrighetti, Luca, Torzilli, Guido, Romano, Fabrizio, Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Carissimi, F., Perri, P., Iaria, M., Dominioni, T., Zanello, M., Conci, S., Molfino, S., Labarba, G., Ferrari, C., Germani, P., Patauner, S., Pinotti, E., Lodo, E., Garatti, M., Sciannamea, I., Troci, A., Conticchio, M., Floridi, A., Chiarelli, M., Fumagalli, L., Memeo, R., Crespi, M., Antonucci, A., Zimmitti, G., Zanus, G., Zago, M., Frena, A., Tarchi, P., Griseri, G., Ercolani, G., Baiocchi, G. L., Ruzzenente, A., Jovine, E., Maestri, M., Dallavalle, R., Grazi, G. L., Giuliante, F., Aldrighetti, L., Torzilli, G., Romano, F., Bernasconi, D. P., Ciulli, C., Giani, A., Costa, G., Ratti, F., Bellobono, M., Calabrese, F., Cremaschi, E., De Peppo, V., Cucchetti, A., Lazzari, G., Percivale, A., Ciola, M., Sega, V., Frassani, S., Del Vecchio, A., Pennacchi, L., Corleone, P., Cosola, D., Salvador, L., and Montuori, M.

Subjects
Male, Cirrhosis, Outcome Assessment, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Datasets as Topic, HERCOLES, Hepatocarcinoma recurrence, Liver surgery, Redo surgery, Outcome Assessment, Health Care, Ascites, Registries, Laparoscopy, education.field_of_study, medicine.diagnostic_test, Liver Neoplasms, Middle Aged, Italy, Local, Radiological weapon, Female, medicine.symptom, Reoperation, medicine.medical_specialty, Carcinoma, Hepatocellular, Population, NO, Internal medicine, medicine, Hepatectomy, Humans, education, LS7_4, Aged, business.industry, Carcinoma, Hepatocellular, Perioperative, Hepatology, medicine.disease, Surgery, Health Care, Neoplasm Recurrence, Neoplasm Recurrence, Local, business
Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power. Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63–75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020

4. Care or palliation for recurrent hepatocarcinoma: a multicentric national analysis of survival

Author

Famularo, S., primary, Donadon, M., additional, Cipriani, F., additional, Ardito, F., additional, Maestri, M., additional, Dominioni, T., additional, Bernasconi, D.P., additional, Carissimi, F., additional, Iaria, M., additional, Cosimelli, M., additional, LaBarba, G., additional, Molfino, S., additional, Conci, S., additional, Ferrari, C., additional, Patauner, S., additional, Floridi, A., additional, Garatti, M., additional, Antonucci, A., additional, Del Vecchio, A., additional, Chiarelli, M., additional, Fumagalli, L., additional, Troci, A., additional, Percivale, A., additional, De Angelis, M., additional, Lodo, E., additional, Zanello, M., additional, Boccia, L., additional, Crespi, M., additional, Memeo, R., additional, Zanus, G., additional, Zimmitti, G., additional, Frena, A., additional, Griseri, G., additional, Ruzzenente, A., additional, Baiocchi, G.L., additional, Ercolani, G., additional, Grazi, G.L., additional, DallaValle, R., additional, Jovine, E., additional, Giuliante, F., additional, Aldrighetti, L., additional, Torzilli, G., additional, and Romano, F., additional

Published
2020
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5. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

Author

Simone Famularo, Matteo Donadon, Federica Cipriani, Davide P. Bernasconi, Giuliano LaBarba, Tommaso Dominioni, Maurizio Iaria, Sarah Molfino, Simone Conci, Cecilia Ferrari, Marco Garatti, Antonella Delvecchio, Albert Troci, Stefan Patauner, Silvia Frassani, Maurizio Cosimelli, Giacomo Zanus, Felice Giuliante, Elio Jovine, Maria G. Valsecchi, GianLuca Grazi, Adelmo Antonucci, Antonio Frena, Michele Crespi, Riccardo Memeo, Giuseppe Zimmitti, Guido Griseri, Andrea Ruzzenente, Gianluca Baiocchi, Raffaele DallaValle, Marcello Maestri, Giorgio Ercolani, Luca Aldrighetti, Guido Torzilli, Fabrizio Romano, Cristina Ciulli, Alessandro Giani, Francesca Carissimi, Guido Costa, Francesca Ratti, Alessandro Cucchetti, Francesco Calabrese, Elena Cremaschi, Giovanni Lazzari, Angelo Franceschi, Valentina Sega, Maria Conticchio, Luca Pennacchi, Michele Ciola, Ivano Sciannamea, Valerio De Peppo, Famularo S., Donadon M., Cipriani F., Bernasconi D.P., LaBarba G., Dominioni T., Iaria M., Molfino S., Conci S., Ferrari C., Garatti M., Delvecchio A., Troci A., Patauner S., Frassani S., Cosimelli M., Zanus G., Giuliante F., Jovine E., Valsecchi M.G., Grazi G., Antonucci A., Frena A., Crespi M., Memeo R., Zimmitti G., Griseri G., Ruzzenente A., Baiocchi G., DallaValle R., Maestri M., Ercolani G., Aldrighetti L., Torzilli G., Romano F., Ciulli C., Giani A., Carissimi F., Costa G., Ratti F., Cucchetti A., Calabrese F., Cremaschi E., Lazzari G., Franceschi A., Sega V., Conticchio M., Pennacchi L., Ciola M., Sciannamea I., De Peppo V., Famularo, Simone, Donadon, Matteo, Cipriani, Federica, Bernasconi, Davide P, Labarba, Giuliano, Dominioni, Tommaso, Iaria, Maurizio, Molfino, Sarah, Conci, Simone, Ferrari, Cecilia, Garatti, Marco, Delvecchio, Antonella, Troci, Albert, Patauner, Stefan, Frassani, Silvia, Cosimelli, Maurizio, Zanus, Giacomo, Giuliante, Felice, Jovine, Elio, Valsecchi, Maria G, Grazi, Gianluca, Antonucci, Adelmo, Frena, Antonio, Crespi, Michele, Memeo, Riccardo, Zimmitti, Giuseppe, Griseri, Guido, Ruzzenente, Andrea, Baiocchi, Gianluca, Dallavalle, Raffaele, Maestri, Marcello, Ercolani, Giorgio, Aldrighetti, Luca, Torzilli, Guido, and Romano, Fabrizio

Subjects
Sorafenib, medicine.medical_specialty, recurrence, Carcinoma, Hepatocellular, Tumor burden, 030230 surgery, liver, Gastroenterology, NO, 03 medical and health sciences, 0302 clinical medicine, hepatectomy, Retrospective Studie, Internal medicine, Humans, Medicine, Chemoembolization, Therapeutic, Liver surgery, Retrospective Studies, LS7_4, Hepatology, business.industry, Palliative Care, Liver Neoplasms, hepatocellular carcinoma, medicine.disease, Recurrent Hepatocellular Carcinoma, multicentric, Treatment Outcome, Time to recurrence, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Liver function, Neoplasm Recurrence, Local, business, medicine.drug, Human
Abstract

Background Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC. Methods This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups. Results 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p Conclusion Curative approaches may guarantee long-term survival in case of recurrence.

Published
2021

6. Impact of induction therapy on bacterial infections and long-term outcome in adult intestinal and multivisceral transplantation: a comparison of two different induction protocols: daclizumab vs. alemtuzumab

Author

Massimo Del Gaudio, Giuliano LaBarba, Alessandro Dazzi, Matteo Cescon, Chiara Zanfi, Augusto Lauro, Antonio Daniele Pinna, Tiziana Lazzarotto, Marco Vivarelli, Giorgio Ercolani, Takuya Kimura, Gian Luca Grazi, Matteo Zanello, Loris Pironi, Alessandro Cucchetti, Matteo Ravaioli, Kimura T, Lauro A, Cescon M, Zanfi C, Dazzi A, Ercolani G, Grazi GL, Vivarelli M, Ravaioli M, Del Gaudio M, Cucchetti A, Zanello M, LaBarba G, Pironi L, Lazzarotto T, and Pinna AD.

Subjects
Adult, Male, INTESTINAL TRANSPLANTATION, medicine.medical_specialty, Transplantation Conditioning, Adolescent, Antibodies, Neoplasm, medicine.medical_treatment, DACLIZUMAB, Antibodies, Monoclonal, Humanized, Gastroenterology, NO, Young Adult, Postoperative Complications, Daclizumab, Pharmacotherapy, small bowel transplantation, Internal medicine, medicine, alemtuzumab, Humans, Survival analysis, Retrospective Studies, Transplantation, Chemotherapy, IMMUNOSUPPRESSION, induction therapy – intestinal transplantation, ALENTUZUMAB, business.industry, Incidence (epidemiology), bacterial infection, Antibodies, Monoclonal, Bacterial Infections, Middle Aged, INDUCTION THERAPY, Survival Analysis, Tacrolimus, Surgery, Intestines, Immunoglobulin G, alemtuzumab, bacterial infection, induction therapy – intestinal transplantation, small bowel transplantation, Alemtuzumab, Female, business, Immunosuppressive Agents, medicine.drug
Abstract

Introduction: Induction therapy with daclizumab or alemtuzumab has been recently introduced for intestinal transplantation; however, the impact of such induction therapy on bacterial infections remains to be clarified. The purpose of this study was to evaluate the impact of induction therapy on the incidence of bacterial infections and long-term patient survival. Patients and methods: Over the past seven yr, we performed 39 intestinal (ITx) and multivisceral (MTVx) transplants in 38 adult patients. In the early period, daclizumab was used for induction, and tacrolimus and steroids were administered for maintenance [daclizumab and tacrolimus (DT) group; n = 11]. From 2002, we used alemtuzumab for induction, with low-dose tacrolimus maintenance [alemtuzumab and tacrolimus (AT) group; n = 23]. The incidence of bacterial infections and patient outcome were compared between the two groups. Results: There were no significant differences in recipient and donor demographics, procedure (ITx vs. MTVx), and cold and warm ischemic time between the two groups. Within 30 d after ITx, bacterial infections were observed in seven patients (64%) in the DT and in 14 patients (64%) in the AT group. Between 30 and 180 d after ITx, a total of 17 episodes of bacterial infections were observed in the DT and 26 episodes in the AT group. Three patients in the DT and eight in the AT group died, and all of the deaths were related to infectious complications except one each in DT and AT. Conclusion: There was no difference in incidence of bacterial infections and long-term patient survival between the two groups.

Published
2009

7. Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison.

Author

Famularo S, Donadon M, Cipriani F, Bernasconi DP, LaBarba G, Dominioni T, Iaria M, Molfino S, Conci S, Ferrari C, Garatti M, Delvecchio A, Troci A, Patauner S, Frassani S, Cosimelli M, Zanus G, Giuliante F, Jovine E, Valsecchi MG, Grazi G, Antonucci A, Frena A, Crespi M, Memeo R, Zimmitti G, Griseri G, Ruzzenente A, Baiocchi G, DallaValle R, Maestri M, Ercolani G, Aldrighetti L, Torzilli G, and Romano F

Subjects
Humans, Neoplasm Recurrence, Local therapy, Palliative Care, Retrospective Studies, Treatment Outcome, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic, Liver Neoplasms therapy
Abstract

Background: Management of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC., Methods: This is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups., Results: 1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14-2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22-2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54-0.69; p<0.001)., Conclusion: Curative approaches may guarantee long-term survival in case of recurrence., (Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Published
2021
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8. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience.

Author

Famularo S, Donadon M, Cipriani F, Ardito F, Carissimi F, Perri P, Iaria M, Dominioni T, Zanello M, Conci S, Molfino S, LaBarba G, Ferrari C, Germani P, Patauner S, Pinotti E, Lodo E, Garatti M, Sciannamea I, Troci A, Conticchio M, Floridi A, Chiarelli M, Fumagalli L, Memeo R, Crespi M, Antonucci A, Zimmitti G, Zanus G, Zago M, Frena A, Tarchi P, Griseri G, Ercolani G, Baiocchi GL, Ruzzenente A, Jovine E, Maestri M, DallaValle R, Grazi GL, Giuliante F, Aldrighetti L, Torzilli G, and Romano F

Subjects
Aged, Carcinoma, Hepatocellular epidemiology, Female, Hepatectomy methods, Hepatectomy trends, Humans, Italy epidemiology, Laparoscopy methods, Laparoscopy trends, Liver Neoplasms epidemiology, Male, Middle Aged, Neoplasm Recurrence, Local, Registries, Reoperation, Carcinoma, Hepatocellular surgery, Datasets as Topic, Liver Neoplasms surgery, Outcome Assessment, Health Care methods
Abstract

Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.

Published
2020
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9. Impact of induction therapy on bacterial infections and long-term outcome in adult intestinal and multivisceral transplantation: a comparison of two different induction protocols: daclizumab vs. alemtuzumab.

Author

Kimura T, Lauro A, Cescon M, Zanfi C, Dazzi A, Ercolani G, Grazi GL, Vivarelli M, Ravaioli M, Del Gaudio M, Cucchetti A, Zanello M, LaBarba G, Pironi L, Lazzarotto T, and Pinna AD

Subjects
Adolescent, Adult, Alemtuzumab, Antibodies, Monoclonal, Humanized, Daclizumab, Female, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Survival Analysis, Young Adult, Antibodies, Monoclonal adverse effects, Antibodies, Neoplasm adverse effects, Bacterial Infections etiology, Immunoglobulin G adverse effects, Immunosuppressive Agents adverse effects, Intestines transplantation, Transplantation Conditioning adverse effects
Abstract

Introduction: Induction therapy with daclizumab or alemtuzumab has been recently introduced for intestinal transplantation; however, the impact of such induction therapy on bacterial infections remains to be clarified. The purpose of this study was to evaluate the impact of induction therapy on the incidence of bacterial infections and long-term patient survival., Patients and Methods: Over the past seven yr, we performed 39 intestinal (ITx) and multivisceral (MTVx) transplants in 38 adult patients. In the early period, daclizumab was used for induction, and tacrolimus and steroids were administered for maintenance [daclizumab and tacrolimus (DT) group; n = 11]. From 2002, we used alemtuzumab for induction, with low-dose tacrolimus maintenance [alemtuzumab and tacrolimus (AT) group; n = 23]. The incidence of bacterial infections and patient outcome were compared between the two groups., Results: There were no significant differences in recipient and donor demographics, procedure (ITx vs. MTVx), and cold and warm ischemic time between the two groups. Within 30 d after ITx, bacterial infections were observed in seven patients (64%) in the DT and in 14 patients (64%) in the AT group. Between 30 and 180 d after ITx, a total of 17 episodes of bacterial infections were observed in the DT and 26 episodes in the AT group. Three patients in the DT and eight in the AT group died, and all of the deaths were related to infectious complications except one each in DT and AT., Conclusion: There was no difference in incidence of bacterial infections and long-term patient survival between the two groups.

Published
2009
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