In:
Liver International, Wiley, Vol. 35, No. 1 ( 2015-01), p. 223-231
Abstract:
Significant proportion of Hepatocellular Carcinoma ( HCC ) cases are diagnosed in stage B of Barcelona Clinic Liver Cancer ( BCLC ) algorithm, in which the standard of care is Transcatheter Arterial ChemoEmbolization ( TACE ). We aimed to ascertain adherence to current guidelines, survival and prognostic factors in BCLC stage B patients. Methods From 3027 HCC cases recruited from 1986 to 2008 by the Italian Liver Cancer group (2430 with data allowing a correct allocation in the BCLC system), a retrospective analysis was conducted on those diagnosed in BCLC stage B (405 patients, 17%). Statistics were performed with Kaplan–Meier (log rank) method and Cox multivariate analysis. Results Median overall survival in BCLC stage B patients was 25 months (Confidence Interval ‐ C.I. ‐ 22–28 months) with a 5‐year survival of 18%. Child–Pugh class, oesophageal varices and Alpha‐foetoprotein ( AFP ) were the independent predictors of survival. TACE was applied in 40% of cases and did not offer the longest survival in comparison with surgical or percutaneous treatments (median 27 months vs. 37 and 36 months, respectively) ( P 〈 0.001). BCLC stage B patients undergoing radical treatments were more frequently in Child‐Pugh class A and had a significantly lower number of lesions; patients undergoing best supportive care were frequently in Child‐Pugh class B and had a multifocal disease. Survival after TACE did not significantly increase over time. Conclusions In clinical practice, TACE cannot be considered the best approach for BCLC stage B patients who represent a heterogeneous population and are often suitable for more aggressive therapies, which lead to a better survival.
Type of Medium:
Online Resource
ISSN:
1478-3223
,
1478-3231
DOI:
10.1111/liv.2015.35.issue-1
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
2124684-1