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

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          Abstract

          The Barcelona Clinic Liver Cancer (BCLC) 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 subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified 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 (AFP) 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 < 0.001). Among MVI patients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHS patients (51.7%). Independent prognostic factors were: Model for End-stage Liver Disease score, Child-Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type.

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          Author and article information

          Journal
          Hepatology
          Hepatology (Baltimore, Md.)
          Wiley
          1527-3350
          0270-9139
          May 2018
          : 67
          : 5
          Affiliations
          [1 ] Department of Internal Medicine, Gastroenterology Unit, San Martino Polyclinic, University of Genova, Genova, Italy.
          [2 ] Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
          [3 ] Operative Unit of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
          [4 ] Biomedical Department of Internal and Specialistic Medicine, Gastroenterology, Palermo, Italy.
          [5 ] Department of Medical and Surgical Sciences, Internal Medicine Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
          [6 ] Biomedical Department of Internal and Specialistic Medicine, Internal Medicin 2 Unit, Villa Sofia Hospital Agency Riuniti Hospitals-Cervello, Palermo, Italy.
          [7 ] Gastroenterology, Physiopathology and Digestive Endoscopy, Central Hospital of Bolzano, Bolzano, Italy.
          [8 ] Surgery Division, San Marco Polyclinic, Zingonia, Italy.
          [9 ] Department of Internal Medicine, Infermi Hospital of Faenza, Faenza, Italy.
          [10 ] Gastroenterology and Metabolic Diseases Unit, Hospital-University Agency of Pisa, Pisa, Italy.
          [11 ] Department of Gastroenterology, Gastroenterology, Polytechnic-University of Marche, Ancona, Italy.
          [12 ] Department of Surgical and Gastroenterological Sciences, Gastroenterology, University of Padova, Italy.
          [13 ] Department of Internal Medicine, Cattolica University of Rome, Rome, Italy.
          [14 ] Department of Oncohematology and Internal Medicine, Infection diseases and Hepatology Unit, Parma, Italy.
          [15 ] Internal Medicine and Gastroenterology Unit-Gemelli, Department of Internal Medicine, Rome, Italy.
          [16 ] Medicine Division, Bolognini Hospital Agency, Seriate, Italy.
          [17 ] Gastroenterology Unit, Department of Clinical and Sperimental Medicine, Naples, Italy.
          [18 ] Department of Medical and Surgical Sciences, Zoli Internal Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
          [19 ] Gastroenterology, Sacro Cuore Don Calabria Hospital, Negrar, Italy.
          [20 ] Department of Internal Medicine and Hepatology, Fatebenefratelli Hospital, Milan, Italy.
          [21 ] Department of Molecular Medicine, University of Padova, Padova, Italy.
          [22 ] Internal Medicine and Hepatology, Department of Sperimental and Clinical Medicine, Florence, Italy.
          [23 ] Department of Medical and Surgical Sciences, Gastroenterology Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
          [24 ] Department of Clinical and Surgical Medicine-Federico II University, Naples, Italy.
          Article
          10.1002/hep.29668
          29159910
          243fee96-fff2-47ba-92d1-931334dec7ec
          History

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