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Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study

Authors :
Vitale, A
Farinati, F
Noaro, G
Burra, P
Pawlik, Tm
Bucci, L
Giannini, Eg
Faggiano, C
Ciccarese, F
Rapaccini, Gl
Di Marco, M
Caturelli, E
Zoli, M
Borzio, F
Sacco, R
Cabibbo, G
Virdone, R
Marra, F
Felder, M
Morisco, F
Benvegnù, L
Gasbarrini, A
Svegliati-Baroni, G
Foschi, Fg
Olivani, A
Masotto, A
Nardone, G
Colecchia, A
Fornari, F
Marignani, M
Vicari, S
Bortolini, E
Cozzolongo, R
Grasso, A
Aliberti, C
Bernardi, M
Frigo, Ac
Borzio, M
Trevisani, F
Cillo, U
CA) group, Italian Liver Cancer (ITA. LI.
Vitale, Alessandro
Farinati, Fabio
Noaro, Giulia
Burra, Patrizia
Pawlik, Timothy M.
Bucci, Laura
Giannini, Edoardo G.
Faggiano, Chiara
Ciccarese, Francesca
Rapaccini, Gian Lodovico
Di Marco, Maria
Caturelli, Eugenio
Zoli, Marco
Borzio, Franco
Sacco, Rodolfo
Cabibbo, Giuseppe
Virdone, Roberto
Marra, Fabio
Felder, Martina
Morisco, Filomena
Benvegnù, Luisa
Gasbarrini, Antonio
Svegliati-Baroni, Gianluca
Foschi, Francesco Giuseppe
Olivani, Andrea
Masotto, Alberto
Nardone, Gerardo
Colecchia, Antonio
Fornari, Fabio
Marignani, Massimo
Vicari, Susanna
Bortolini, Emanuela
Cozzolongo, Raffaele
Grasso, Alessandro
Aliberti, Camillo
Bernardi, Mauro
Frigo, Anna Chiara
Borzio, Mauro
Trevisani, Franco
Cillo, Umberto
Publication Year :
2018

Abstract

Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively). Conclusion: Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.

Details

Language :
English
Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....fe71d306e8b938cc1eb47bceccfd7c73