Monofocal hepatocellular carcinoma: How much does size matter?
bclc staging system
liver resection
monofocal hepatocellular carcinoma
prognosis
treatment
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
06
08
2020
revised:
07
10
2020
accepted:
31
10
2020
pubmed:
7
11
2020
medline:
22
6
2021
entrez:
6
11
2020
Statut:
ppublish
Résumé
According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5 cm) monofocal (HCC). From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5 cm; SEM-HCC), 163 patients with larger tumours (>5 cm; LEM-HCC) and 1048 intermediate stage patients (BCLC B). LEM-HCC patients had a worse overall survival (OS) than SEM-HCC (31.0 vs 49.0 months; P < .0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29-2.05; P < .0001). The small difference in OS between LEM-HCC and BCLC B patients (31.0 vs 27.0 months; P = .03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77-1.25; P = .89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from "curative" to "palliative" therapies. The survival of resected patients with LEM-HCC was significantly shorter than that of SEM-HCC (44.0 vs 78.0 months; P = .002), but liver resection provided the highest survival benefit in both groups compared to other treatments. Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients.
Sections du résumé
BACKGROUND & AIMS
According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5 cm) monofocal (HCC).
METHODS
From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5 cm; SEM-HCC), 163 patients with larger tumours (>5 cm; LEM-HCC) and 1048 intermediate stage patients (BCLC B).
RESULTS
LEM-HCC patients had a worse overall survival (OS) than SEM-HCC (31.0 vs 49.0 months; P < .0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29-2.05; P < .0001). The small difference in OS between LEM-HCC and BCLC B patients (31.0 vs 27.0 months; P = .03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77-1.25; P = .89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from "curative" to "palliative" therapies. The survival of resected patients with LEM-HCC was significantly shorter than that of SEM-HCC (44.0 vs 78.0 months; P = .002), but liver resection provided the highest survival benefit in both groups compared to other treatments.
CONCLUSIONS
Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
396-407Investigateurs
Maurizio Biselli
(M)
Paolo Caraceni
(P)
Francesca Garuti
(F)
Annagiulia Gramenzi
(A)
Andrea Neri
(A)
Valentina Santi
(V)
Alessandro Granito
(A)
Luca Muratori
(L)
Fabio Piscaglia
(F)
Vito Sansone
(V)
Francesco Tovoli
(F)
Elton Dajti
(E)
Giovanni Marasco
(G)
Federico Ravaioli
(F)
Alberta Cappelli
(A)
Rita Golfieri
(R)
Cristina Mosconi
(C)
Matteo Renzulli
(M)
Ambra Sammarco
(A)
Ester Marina Cela
(EM)
Antonio Facciorusso
(A)
Valentina Cacciato
(V)
Edoardo Casagrande
(E)
Alessandro Moscatelli
(A)
Gaia Pellegatta
(G)
Nicoletta de Matthaeis
(N)
Gloria Allegrini
(G)
Valentina Lauria
(V)
Giorgia Ghittoni
(G)
Giorgio Pelecca
(G)
Fabrizio Chegai
(F)
Fabio Coratella
(F)
Mariano Ortenzi
(M)
Gabriele Missale
(G)
Alessandro Inno
(A)
Fabiana Marchetti
(F)
Anita Busacca
(A)
Giuseppe Cabibbo
(G)
Calogero Cammà
(C)
Vincenzo Di Martino
(VD)
Giacomo Emanuele Maria Rizzo
(G)
Maria Stella Franzè
(MS)
Carlo Saitta
(C)
Assunta Sauchella
(A)
Vittoria Bevilacqua
(V)
Alberto Borghi
(A)
Andrea Casadei Gardini
(A)
Fabio Conti
(F)
Anna Chiara Dall'Aglio
(AC)
Giorgio Ercolani
(G)
Federica Mirici
(F)
Claudia Campani
(C)
Chiara Di Bonaventura
(CD)
Stefano Gitto
(S)
Pietro Coccoli
(P)
Antonio Malerba
(A)
Maria Guarino
(M)
Maurizia Brunetto
(M)
Veronica Romagnoli
(V)
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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