Application of the Intermediate-Stage Subclassification to Patients With Untreated Hepatocellular Carcinoma

作者：Giannini Edoardo G; Moscatelli Alessandro; Pellegatta Gaia; Vitale Alessandro; Farinati Fabio; Ciccarese Francesca; Piscaglia Fabio; Rapaccini Gian Lodovico; Di Marco Maria; Caturelli Eugenio; Zoli Marco; Borzio Franco; Cabibbo Giuseppe; Felder Martina; Sacco Rodolfo; Morisco Filomena; Missale Gabriele; Foschi Francesco Giuseppe; Ga**arrini Antonio; Baroni Gianluca Svegliati; Virdone Roberto; Masotto Alberto; Trevisani Franco; Grp Italian Liver Canc I T A L I C A

来源：American Journal of Gastroenterology, 2016, 111(1): 70-77.

DOI：10.1038/ajg.2015.389

OBJECTIVES: The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group.
METHODS: We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages.
RESULTS: Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P < 0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P < 0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P < 0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival.
CONCLUSIONS: The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients.

• 出版日期2016-1