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2. Pattern of macrovascular invasion in hepatocellular carcinoma

Author

Guarino, M., Cucchetti, A., Pontillo, G., Farinati, F., Benevento, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Rodolfo, S., Cabibbo, G., Marra, F., Mega, A., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Giannini, E. G., Morisco, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Rampoldi, D., Santi, V., Forgione, A., Granito, A., Muratori, L., Piscaglia, F., Sansone, V., Tovoli, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Cela, E. M., Facciorusso, A., Pelizzaro, F., Imondi, A., Sartori, A., Penzo, B., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., Pieri, G., de Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Olivari, A., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Berardinelli, D., Ercolani, G., Napoli, L., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Capasso, M., Fiorentino, A., Pignata, L., Cossiga, V., Romagnoli, V., Guarino M., Cucchetti A., Pontillo G., Farinati F., Benevento F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Rodolfo S., Cabibbo G., Marra F., Mega A., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Missale G., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Oliveri F., Trevisani F., Giannini E.G., Morisco F., Biselli M., Caraceni P., Garuti F., Gramenzi A., Neri A., Rampoldi D., Santi V., Forgione A., Granito A., Muratori L., Piscaglia F., Sansone V., Tovoli F., Dajti E., Marasco G., Ravaioli F., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Cela E.M., Facciorusso A., Pelizzaro F., Imondi A., Sartori A., Penzo B., Cacciato V., Casagrande E., Moscatelli A., Pellegatta G., Pieri G., de Matthaeis N., Allegrini G., Lauria V., Ghittoni G., Pelecca G., Chegai F., Coratella F., Ortenzi M., Olivari A., Inno A., Marchetti F., Busacca A., Camma C., Di Martino V., Rizzo G.E.M., Franze M.S., Saitta C., Sauchella A., Bevilacqua V., Borghi A., Gardini A.C., Conti F., Berardinelli D., Ercolani G., Napoli L., Campani C., Di Bonaventura C., Gitto S., Coccoli P., Malerba A., Capasso M., Fiorentino A., Pignata L., Cossiga V., Romagnoli V., Guarino, M., Cucchetti, A., Pontillo, G., Farinati, F., Benevento, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Rodolfo, S., Cabibbo, G., Marra, F., Mega, A., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Giannini, E. G., Morisco, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Rampoldi, D., Santi, V., Forgione, A., Granito, A., Muratori, L., Piscaglia, F., Sansone, V., Tovoli, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Cela, E. M., Facciorusso, A., Pelizzaro, F., Imondi, A., Sartori, A., Penzo, B., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., Pieri, G., de Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Olivari, A., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Berardinelli, D., Ercolani, G., Napoli, L., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Capasso, M., Fiorentino, A., Pignata, L., Cossiga, V., and Romagnoli, V.

Subjects
Ablation Techniques, Male, Registrie, Cirrhosis, Clinical Biochemistry, Mesenteric Vein, loco-regional treatment, 030204 cardiovascular system & hematology, Biochemistry, Gastroenterology, surgery, Antineoplastic Agent, Liver disease, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, cirrhosis, hepatocellular carcinoma, portal vein thrombosis, transplantation, Ascites, Ablation Technique, Registries, 030212 general & internal medicine, Chronic, Settore MED/12 - Gastroenterologia, Portal Vein, Liver Diseases, Liver Neoplasms, General Medicine, Middle Aged, Sorafenib, Prognosis, Hepatitis B, Alcoholic, Hepatitis C, Tumor Burden, Survival Rate, Italy, Liver Neoplasm, Hepatocellular carcinoma, Ascite, Female, medicine.symptom, Liver cancer, Human, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Antineoplastic Agents, End Stage Liver Disease, 03 medical and health sciences, Mesenteric Veins, Hepatitis B, Chronic, Internal medicine, medicine, Humans, Hepatectomy, Neoplasm Invasiveness, portal vein thrombosi, Liver Diseases, Alcoholic, Aged, Neoplasm Invasivene, Performance status, business.industry, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Patient Acuity, Hepatocellular, Hepatitis C, Chronic, medicine.disease, Liver Transplantation, Transplantation, Liver function, business, cirrhosi
Abstract

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4months in those with PS>1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Published
2021

3. The Apparent Asymmetrical Relationship Between Small Bowel Bacterial Overgrowth, Endotoxemia, and Liver Steatosis and Fibrosis in Cirrhotic and Non-Cirrhotic Patients: A Single-Center Pilot Study

Author

Scarpellini, E., Abenavoli, L., Cassano, V., Rinninella, Emanuele, Sorge, M., Capretti, F., Rasetti, C., Svegliati Baroni, G., Luzza, F., Santori, P., and Sciacqua, A.

Subjects
liver steatosis, gut microbiota, fibrosis, Settore MED/09 - MEDICINA INTERNA, dysbiosis, small intestinal bacterial overgrowth, General Medicine
Abstract

IntroductionGut microbiota are a complex ecosystem harboring our intestine. They maintain human body equilibrium, while their derangement, namely, “dysbiosis“, has been associated with several gastrointestinal diseases, such as liver steatosis (NAFLD) and liver cirrhosis. Small intestinal bacterial overgrowth (SIBO) is an example of dysbiosis of the upper gastrointestinal (GI) tract.AimThe aim of this study is to evaluate the relationship between SIBO and levels of endotoxemia and grade of liver steatosis (LS) and liver fibrosis (LF) in hepatologic patients.Materials and MethodsConsecutive outpatients referred to our hepatology clinic were tested for SIBO by the lactulose breath test (LBT) and peripheral blood levels of endotoxemia; LS grading and LF were assessed by abdominal ultrasound and transient elastography, respectively.ResultsFifty-two consecutive patients (17 with alcohol abuse (4.5 ± 0.8 alcohol units per day), 4 with HCV and 2 with HBV infection, 24 of metabolic origin, 2 of autoimmune origin, and 3 with cholangiopathies; mean age 54.7 ± 8.3 years, 31 F, BMI 24.1 ± 1.1 Kg/m2) and 14 healthy volunteers (HV) (mean age 50.1 ± 4.3 years, 9 F, BMI 23.3 ± 1.1 Kg/m2) were enrolled. SIBO prevalence was significantly higher in cirrhotic (LC) vs. non-cirrhotic (LNC) patients and vs. HV (all, p < 0.05), with a significant positive trend according to Child-Pugh status (all, p < 0.05). SIBO prevalence was not correlated with LS stages (all, p = NS). Consensually, endotoxin levels were significantly higher in LC vs. LNC and vs. HV (all, p < 0.05) and significantly correlated with LF in patients with LC, according to Child-Pugh status (all, p < 0.05).ConclusionThis study shows that SIBO prevalence and relative endotoxin blood levels seem to be significantly associated with the grade of LF vs. LS in LC. SIBO is also present under pre-cirrhotic conditions, but its prevalence seems to correlate with liver disease irreversible derangement.

Published
2022

6. Rise and fall of HCV-related hepatocellular carcinoma in Italy: a long-term survey from the ITA.LI.CA centres

Author

Cazzagon N, Maddalo G, Giacomin A, Vanin V, Pozzan C, Del Poggio P, Rapaccini G, Di Nolfo AM, Benvegnù L, Borzio F, Giannini EG, Caturelli E, Chiaramonte M, Foschi FG, Cabibbo G, Felder M, Ciccarese F, Missale G, Svegliati Baroni G, Morisco F, Farinati F, The Italian Liver Cancer Group [. . ., DOMENICALI, MARCO, TREVISANI, FRANCO, ZOLI, MARCO, BOLONDI, LUIGI, BERNARDI, MAURO, Cazzagon, N, Trevisani, F, Maddalo, G, Giacomin, A, Vanin, V, Pozzan, C, Del Poggio, P, Rapaccini, G, Di Nolfo, AM, Benvegnù, L, Zoli, M, Borzio, F, Giannini, EG, Caturelli, E, Chiaramonte, M, Foschi, FG, Cabibbo, G, Felder, M, Ciccarese, F, Missale, G, Svegliati Baroni, G, Morisco, F, Pecorelli, A, Farinati, F., Di Nolfo, Am, Benvegn?, L, Giannini, Eg, Foschi, Fg, Morisco, Filomena, Farinati, F, CA Group, for the I. T. A. L. I., Cazzagon N, Trevisani F, Maddalo G, Giacomin A, Vanin V, Pozzan C, Del Poggio P, Rapaccini G, Di Nolfo AM, Benvegnù L, Zoli M, Borzio F, Giannini EG, Caturelli E, Chiaramonte M, Foschi FG, Cabibbo G, Felder M, Ciccarese F, Missale G, Svegliati Baroni G, Morisco F, Pecorelli A, Farinati F, The Italian Liver Cancer (ITA.LI.CA) Group [.., Bernardi M, and ]

Subjects
Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, Hepatitis C virus, hepatitis C, hepatocellular carcinoma, cirrhosis, medicine.disease_cause, Gastroenterology, Group B, Sex Factors, Internal medicine, Epidemiology, Prevalence, medicine, Humans, HEPATOCELLULAR CARCINOMA, CIRRHOSIS, Retrospective Studies, Hepatology, business.industry, Incidence, Liver Neoplasms, Age Factors, Retrospective cohort study, Hepatitis C, medicine.disease, Survival Analysis, digestive system diseases, Surgery, Italy, Hepatocellular carcinoma, Etiology, Female, business
Abstract

Background & Aims Hepatitis C virus (HCV) is the leading aetiological factor of HCC in the western world where, overall, its incidence is increasing, despite data suggesting an initial drop in some areas. The aim of this study was to evaluate epidemiology, clinical features and survival of HCV-related HCC (HCV-HCC) in a wide time range in Italy. Methods Multicentre retrospective study including 3695 patients prospectively recruited by the ITA.LI.CA group. Patients were classified into three subgroups according to aetiology (Group A[GA], pure HCV; Group B[GB], HCV + cofactors; and Group C[GC], non-HCV) and in 5 time cohorts (5 years each), according to the year of diagnosis. Age, gender, Child–Pugh score, modality of diagnosis, stage, presence of thrombosis/metastases, type of treatment and survival were analysed. Results A total of 1801 GA patients, 445 GB and 1333 GC were recruited. The number of GA patients peaked in the 1996–2000, gradually dropping thereafter (P

Published
2013

7. Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study

Author

Vitale A, Burra P, Frigo AC, Farinati F, Spolverato G, Volk M, Giannini EG, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Borzio F, Cabibbo G, Felder M, Gasbarrini A, Sacco R, Foschi FG, Missale G, Morisco F, Svegliati Baroni G, Virdone R, Cillo U, Italian Liver Cancer group, TREVISANI, FRANCO, PISCAGLIA, FABIO, ZOLI, MARCO, BERNARDI, MAURO, BOLONDI, LUIGI, BISELLI, MAURIZIO, CARACENI, PAOLO, CUCCHETTI, ALESSANDRO, DOMENICALI, MARCO, GRAMENZI, ANNAGIULIA, Vitale, A., Burra, P., Frigo, A. C., Trevisani, F., Farinati, F., Spolverato, G., Volk, M., Giannini, E. G., Ciccarese, F., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Cabibbo, G., Felder, M., Gasbarrini, A., Sacco, R., Foschi, F. G., Missale, G., Morisco, F., Svegliati Baroni, G., Virdone, R., Cillo, U, Olmi, S, on behalf of Italian Liver Cancer, (ITA. LI. CA) group., Vitale, Alessandro, Burra, Patrizia, Frigo, Anna Chiara, Trevisani, Franco, Farinati, Fabio, Spolverato, Gaya, Volk, Michael, Giannini, Edoardo G, Ciccarese, Francesca, Piscaglia, Fabio, Rapaccini, Gian Lodovico, Di Marco, Mariella, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Cabibbo, Giuseppe, Felder, Martina, Gasbarrini, Antonio, Sacco, Rodolfo, Foschi, Francesco Giuseppe, Missale, Gabriele, Morisco, Filomena, Svegliati Baroni, Gianluca, Virdone, Roberto, Cillo, Umberto, Guarino, Maria, Vitale A, Burra P, Frigo AC, Trevisani F, Farinati F, Spolverato G, Volk M, Giannini EG, Ciccarese F, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Cabibbo G, Felder M, Gasbarrini A, Sacco R, Foschi FG, Missale G, Morisco F, Svegliati Baroni G, Virdone R, Cillo U, Italian Liver Cancer (ITA.LI.CA) group, Bernardi M, Bolondi L, Biselli M, Caraceni P, Cucchetti A, Domenicali M, and Gramenzi A

Subjects
Male, medicine.medical_specialty, Cirrhosis, Carcinoma, Hepatocellular, Loco-regional therapie, Hepatocellular carcinoma, Settore MED/12 - GASTROENTEROLOGIA, Hepatitis C virus, Kaplan-Meier Estimate, medicine.disease_cause, Gastroenterology, Cohort Studies, Liver disease, Interquartile range, Internal medicine, medicine, Humans, Best supportive care, Liver resection, Loco-regional therapies, Survival benefit, Aged, Female, Italy, Liver Neoplasms, Middle Aged, Multivariate Analysis, Neoplasm Staging, Prognosis, Treatment Outcome, Medicine (all), Hepatology, BEST SUPPORTING CARE, Cirrhosi, Performance status, business.industry, CIRRHOISIS, Carcinoma, Hepatocellular, medicine.disease, BCLC Stage, Liver cancer, business
Abstract

Background & Aims The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. Methods Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection - MS LRT)/MS BSC. Results After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0 = 62% (40%, 82%), A = 45% (13%, 65%), B = 46% (9%, 76%), C = -16% (-55%, 33%). Model for end-stage liver disease (MELD) score >9, Child B class, and performance status (PST) = 2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD ≤9 and PST 9 or PST = 2 or Child B class), resection did not prove any survival benefit over LRT. Conclusions Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD >9) and PST >1 are absent.

Published
2014

8. Estimation of lead-time bias and its impact on the outcome of surveillance for the early diagnosis of hepatocellular carcinoma

Author

Cucchetti A., Trevisani F., Pecorelli A., Erroi V., Farinati F., Ciccarese F., Rapaccini G. L., Di Marco M., Caturelli E., Giannini E. G., Zoli M., Borzio F., Cabibbo G., Felder M., Gasbarrini A., Sacco R., Foschi F. G., Missale G., Morisco F., Baroni G. S., Virdone R., Bernardi M., Pinna A. D., Bolondi L., Biselli M., Caraceni P., Garuti F., Gramenzi A., Lenzi B., Magalotti D., Piscaglia F., Serra C., Ravaioli M., Venerandi L., Del Poggio P., Olmi S., Balsamo C., Di Nolfo M. A., Vavassori E., Alberti A., Benvegnu L., Gatta A., Giacomin A., Vanin V., Pozzan C., Maddalo G., Giampalma E., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Dell'Isola S., Ialungo A. M., Roselli P., Risso D., Marenco S., Sammito G., Bruzzone L., Bosco G., Grieco A., Pompili M., Rinninella E., Siciliano M., Chiaramonte M., Guarino M., Camma C., Maida M., Di Martino A., Barcellona M. R., Schiada L., Gemini S., Biasini E., Porro E., del Ricambio M., Mismas V., Vivaldi C., Cucchetti, A, Trevisani, F, Pecorelli, A, Erroi, V, Farinati, F, Ciccarese, F, Rapaccini, Gl, Di Marco, M, Caturelli, E, Giannini, Eg, Zoli, M, Borzio, F, Cabibbo, G, Felder, M, Gasbarrini, A, Sacco, R, Foschi, Fg, Missale, G, Morisco, Filomena, Baroni, G, Virdone, R, Bernardi, M, Pinna, Ad, Italian Liver Cancer, Group, Alessandro, Cucchetti, Franco, Trevisani, Anna, Pecorelli, Virginia, Erroi, Fabio, Farinati, Francesca, Ciccarese, Gian, Lodovico Rapaccini, Mariella Di, Marco, Eugenio, Caturelli, Edoardo, G. Giannini, Marco, Zoli, Franco, Borzio, Giuseppe, Cabibbo, Martina, Felder, Antonio, Gasbarrini, Rodolfo, Sacco, Francesco, Giuseppe Foschi, Gabriele, Missale, Filomena, Morisco, Gianluca, Svegliati Baroni, Roberto, Virdone, Mauro, Bernardi, Antonio D., Pinna, for the Italian Liver Cancer Group [.., Bolondi, Luigi, Maurizio, Biselli, Piscaglia, Fabio, ]., Cucchetti, A., Trevisani, F., Pecorelli, A., Erroi, V., Farinati, F., Ciccarese, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Giannini, E. G., Zoli, M., Borzio, F., Cabibbo, G., Felder, M., Gasbarrini, A., Sacco, R., Foschi, F. G., Missale, G., Morisco, F., Baroni, G. S., Virdone, R., Bernardi, M., Pinna, A. D., Bolondi, L., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Lenzi, B., Magalotti, D., Piscaglia, F., Serra, C., Ravaioli, M., Venerandi, L., Del Poggio, P., Olmi, S., Balsamo, C., Di Nolfo, M. A., Vavassori, E., Alberti, A., Benvegnu, L., Gatta, A., Giacomin, A., Vanin, V., Pozzan, C., Maddalo, G., Giampalma, E., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Dell'Isola, S., Ialungo, A. M., Roselli, P., Risso, D., Marenco, S., Sammito, G., Bruzzone, L., Bosco, G., Grieco, A., Pompili, M., Rinninella, E., Siciliano, M., Chiaramonte, M., Guarino, M., Camma, C., Maida, M., Di Martino, A., Barcellona, M. R., Schiada, L., Gemini, S., Biasini, E., Porro, E., del Ricambio, M., Mismas, V., and Vivaldi, C.

Subjects
Male, medicine.medical_specialty, Pediatrics, Carcinoma, Hepatocellular, Time Factors, Hepatocellular carcinoma, Settore MED/12 - GASTROENTEROLOGIA, Disease, Gastroenterology, Bias, Internal medicine, Overall survival, medicine, Humans, Early Detection of Cancer, Aged, Estimation, Surveillance, Hepatology, business.industry, Liver Neoplasms, medicine.disease, digestive system diseases, Lead time bias, Cirrhosis, Female, business, Lead-time bias, Follow-Up Studies
Abstract

Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Background & Aims: Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Methods: One-thousand three-hundred and eighty Child–Pugh class A/B patients from the ITA.LI.CA database, in whom HCC was detected during semiannual surveillance (n = 850), annual surveillance (n = 234) or when patients came when symptomatic (n = 296), were selected. Lead-time was estimated by means of appropriate formulas and Monte Carlo simulation, including 1000 patients for each arm. Results: The 5-year overall survival after HCC diagnosis was 32.7% in semiannually surveilled patients, 25.2% in annually surveilled patients, and 12.2% in symptomatic patients (p

Published
2014

9. Electronic portal imaging registration in breast cancer radiotherapy verification: Analysis of inter-observer agreement among different categories of health practitioners

Author

M.C. Leonardi, D. Rozza, Baroni G, Cristiana Fodor, Zurrida S, Anna Morra, Vischioni B, Luigi Santoro, Barbara Alicja Jereczek-Fossa, S.P. Colangione, Roberto Orecchia, Leppa A, L. Morselli, and Raffaella Cambria

Subjects
Adult, Diagnostic Imaging, Cancer Research, medicine.medical_specialty, Radiography, medicine.medical_treatment, Breast Neoplasms, Cohen's kappa, General Practitioners, parasitic diseases, Medical imaging, Humans, Medicine, Medical physics, Practice Patterns, Physicians', Radiation oncologist, Aged, Aged, 80 and over, Observer Variation, business.industry, Radiation Therapist, Radiotherapy Planning, Computer-Assisted, Workload, Middle Aged, Prognosis, Radiographic Image Enhancement, Radiation therapy, Oncology, Radiation Oncology, Female, Electronics, business, Quality assurance
Abstract

Electronic portal imaging (EPI) is commonly used to identify and correct for inter-fraction variability in tangential breast irradiation. Based on the institutional policy, EPI registration is performed by either radiation oncologist or therapist. Little data is available on the inter-observer agreement in EPI registration among different health practitioners. The aim of our study was to analyze inter-observer agreement among radiation oncologists and therapists in the evaluation of EPI for breast cancer radiotherapy verification. EPI data of 40 patients treated with tangential fields were independently reviewed by a radiation oncologist (on-line, just before treatment) and off-line by junior and senior therapists. Displacement of each EPI image with respect to the digital reconstructed radiographs (DRRs) was quantified using manual EPI registration based on bony marks with the corresponding DRRs. Agreement between observers was evaluated using weighted Cohen's Kappa statistics. In 95% out of 720 EPI-DRR comparisons, the EPI-DRR misalignment was < 5 mm. The difference between observers was < 2 mm in 666 (92.5%) out of all 720 delta values. High inter-observer agreement was found, with weighted Cohen's Kappa values attesting evaluation overlaps ranging from moderate (among therapists) to almost perfect (among radiation oncologist and therapists). The high agreement among the observers demonstrated the precision of breast localization using EPI. These findings suggest that routine EPI-based patient set-up verification in breast cancer radiotherapy can be safely entrusted to trained therapists (supervision should be assured based on the local tasks definition). Our study might be useful in quality assurance and in the optimization of workload in the radiotherapy departments. They might allow for wider implementation of complex and evolving radiotherapy technologies.

Published
2013

10. Determinants of alpha-fetoprotein levels in patients with hepatocellular carcinoma: implications for its clinical use

Author

Giannini EG, Sammito G, Farinati F, Ciccarese F, Pecorelli A, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Cabibbo G, Felder M, Gasbarrini A, Sacco R, Foschi FG, Missale G, Svegliati Baroni G, Virdone R, Trevisani F, Italian Liver Cancer Group, MORISCO, FILOMENA, Giannini, Eg, Sammito, G, Farinati, F, Ciccarese, F, Pecorelli, A, Rapaccini, Gl, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Cabibbo, G, Felder, M, Gasbarrini, A, Sacco, R, Foschi, Fg, Missale, G, Morisco, Filomena, Svegliati Baroni, G, Virdone, R, Trevisani, F, and Italian Liver Cancer, Group

Published
2014

11. Improving the clinical applicability of markerless lung tumour tracking with contrast-enhanced kV imaging

Author

Fassi, A., Ciardo, D., Riboldi, M., David Sarrut, Baroni, G., Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano [Milan] (POLIMI), European Institute of Oncology [Milan] (ESMO), Imagerie Tomographique et Radiothérapie, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Léon Bérard [Lyon]

Subjects
[INFO.INFO-IM]Computer Science [cs]/Medical Imaging, respiratory system, respiratory tract diseases
Abstract

International audience; In-room kV imaging is widely applied for intrafraction motion compensation in image-guided radiation therapy (IGRT). The low contrast of lung tumours in kV images and the overlap of high-intensity surrounding structures, such as the mediastinum, may limit the applicability of IGRT techniques in lung cancer treatments. The aim of this study is to apply a CT-based contrast enhancement method to improve markerless lung tumour tracking in kV images, thus enhancing the potential of X-raybased image guidance in lung cancer patients.

Published
2015

12. A novel radioguided surgery technique exploiting $��^{-}$ decays

Author

Camillocci, E. Solfaroli, Baroni, G., Bellini, F., Bocci, V., Collamati, F., Cremonesi, M., De Lucia, E., Ferroli, P., Fiore, S., Grana, C. M., Marafini, M., Mattei, I., Morganti, S., Paganelli, G., Patera, V., Piersanti, L., Recchia, L., Russomando, A., Schiariti, M., Sarti, A., Sciubba, A., Voena, C., and Faccini, R.

Subjects
FOS: Physical sciences, Medical Physics (physics.med-ph), Instrumentation and Detectors (physics.ins-det)
Abstract

The background induced by the high penetration power of the gamma radiation is the main limiting factor of the current Radio-guided surgery (RGS). To partially mitigate it, a RGS with beta+ emitting radio-tracers has been suggested in literature. Here we propose the use of beta- emitting radio-tracers and beta- probes and discuss the advantage of this method with respect to the previously explored ones: the electron low penetration power allows for simple and versatile probes and could extend RGS to tumours for which background originating from nearby healthy tissue makes gamma probes less effective. We developed a beta- probe prototype and studied its performances on phantoms. By means of a detailed simulation we have also extrapolated the results to estimate the performances in a realistic case of meningioma, pathology which is going to be our first in-vivo test case. A good sensitivity to residuals down to 0.1ml can be reached within 1s with an administered activity smaller than those for PET-scans thus making the radiation exposure to medical personnel negligible., 14 pages, 7 figures

Published
2014
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15. EP-1759: Treatment of moving targets with active scanning carbon ion beams

Author

Fossati, P., Bonora, M., Ciurlia, E., Fiore, M., Iannalfi, A., Vischioni, B., Vitolo, V., Hasegawa, A., Mirandola, A., Molinelli, S., Mastella, E., Panizza, D., Russo, S., Pella, A., Tagaste, B., Fontana, G., Riboldi, M., Facoetti, A., Krengli, M., Baroni, G., Ciocca, M., Valvo, F., and Orecchia, R.

Subjects
Oncology, Radiology Nuclear Medicine and imaging, Radiology, Nuclear Medicine and imaging, Hematology
Published
2016

17. O Caráter Multifuncional de Verbos Volitivos do Português do Brasil em Gêneros Jornalísticos

Author

BARONI, G. C., LINS, M. P. P., CEZARIO, M. M., and ROCHA, L. H. P.

Subjects
Gramaticalização de verbos, Verbo, Funcionalismo lingüístico
Abstract

Made available in DSpace on 2016-08-29T15:08:48Z (GMT). No. of bitstreams: 1 tese_5010_DISSERTACAO - Gabriela Baroni.pdf: 2694730 bytes, checksum: ad8a2361ff9991370d3b1ed4415eb8d9 (MD5) Previous issue date: 2011-03-31 O funcionalismo contemporâneo é uma corrente de estudos lingüísticos que concebe a língua como um instrumento de interação social. Para os funcionalistas, a língua deve ser estudada a partir de situações comunicativas reais, orais ou escritas, tendo por base o seu uso pelos falantes. Fundamentada nessa teoria, esta dissertação destina-se à análise dos usos dos verbos volitivos querer, mandar, deixar, desejar, pedir e exigir em dois gêneros textuais do domínio discursivo jornalístico: o artigo de opinião e a entrevista, ambos da revista Veja. Entre os princípios centrais do funcionalismo, o da gramaticalização é o que norteia este trabalho. Concernente a esse princípio, está a proposta de Heine (1993) de que há diferentes estágios que caracterizam a trajetória de verbo pleno a marcador de Tempo, Aspecto e Modo (contínuo Verb-to-TAM) nas línguas. Esses estágios ao todo sete foram chamados pelo autor de Estágio A, Estágio B, e assim sucessivamente, até o Estágio G. Cada um deles possui diferentes características que podem apontar como o verbo tem sido usado pelos falantes. No início do contínuo, ou nos Estágios A e B, estão os verbos plenos. No final, ou nos Estágios F e G, estão o afixo ou a flexão. O auxiliar, por ser uma categoria intermediária, apresenta características de estágios intermediários entre o verbo pleno e a flexão. Assim, de acordo com essa proposta, analisamos os usos dos verbos volitivos querer, mandar, deixar, desejar, pedir e exigir e os classificamos em um dos sete estágios. A análise permite observar que um mesmo verbo pode apresentar usos distintos e, por essa razão, ser classificado em estágios distintos. É possível observar, ainda, que verbos de um mesmo grupo semântico (volitivo) estão em estágios diferentes do contínuo e, por esse motivo, exibem características diferentes de uso pelos falantes. Palavras-chave: Funcionalismo lingüístico. Gramaticalização de verbos. Verbos volitivos.

Published
2011

18. Glucagon-like peptide-1 receptor activation stimulates hepatic lipid oxidation and restores hepatic signalling alteration induced by a high-fat diet in nonalcoholic steatohepatitis

Author

Svegliati Baroni, G, Saccomanno, Sabina, Rychlicki, C, Agostinelli, L, De Minicis, S, Candelaresi, C, Faraci, G, Pacetti, D, Vivarelli, M, Nicolini, Dario Giuseppe Pierpaolo, Garelli, P, Casini, A, Manco, Melania, Mingrone, Geltrude, Risaliti, A, Frega, Gn, Benedetti, Anna, and Gastaldelli, A.

Subjects
Male, Time Factors, Biopsy, GLP-1 receptor, AMP-Activated Protein Kinases, Glucagon-Like Peptide-1 Receptor, Rats, Sprague-Dawley, Hepatic lipid oxidation, Non-alcoholic Fatty Liver Disease, Receptors, Receptors, Glucagon, Animals, Humans, Hypoglycemic Agents, PPAR alpha, High-fat diet, NASH, Cyclic AMP-Dependent Protein Kinases, Dietary Fats, Disease Models, Animal, Fatty Acids, Fatty Liver, Gene Expression Regulation, Hep G2 Cells, Hepatocytes, Insulin Resistance, JNK Mitogen-Activated Protein Kinases, Liver, Oxidation-Reduction, PPAR gamma, Peptides, Phosphorylation, Proto-Oncogene Proteins c-akt, Rats, Signal Transduction, Venoms, Hepatology, Animal, Settore MED/09 - MEDICINA INTERNA, Glucagon, Disease Models, Sprague-Dawley
Published
2011

31. Intracellular pathways mediating estrogen-induced cholangiocyte proliferation in the rat

Author

Alvaro, Domenico, Onori, Paolo, Svegliati Baroni, G., Drudi Metalli, V., Folli, F., Franchitto, Antonio, Alpini, G. F., Mancino, MARIA GRAZIA, Attili, Adolfo Francesco, and Gaudio, Eugenio

Subjects
Male, Mitogen-Activated Protein Kinase 1, Mitogen-Activated Protein Kinase 3, Estradiol, MAP Kinase Signaling System, Estrogen Antagonists, In Vitro Techniques, Rats, Tamoxifen, Bile Ducts, Intrahepatic, Animals, cells, complex, intrahepatic biliary epithelium, activated protein-kinase, receptor-beta, egf, neuroprotection, growth, Mitogen-Activated Protein Kinases, Rats, Wistar, Fulvestrant, Cell Division
Abstract

The aim of this study was to explore the intracellular signaling pathways involved in the stimulatory effects of estrogens on cholangiocyte proliferation. We investigated the tyrosine kinase-receptor pathway by evaluating the protein expression of total and phosphorylated mitogen-activated protein kinase (MAPK) isoform p44/p42 (e.g., extracellular signal-regulated kinase [ERK]1/2), the steroid-receptor coactivator Src and Shc (Src-homology/collagen protein). The study was performed in 3-week-old bile duct-ligated (BDL) rats, BDL rats treated with the antiestrogens, tamoxifen or Ici 182,780, and normal control rats. Proliferation was also evaluated in normal purified cholangiocytes treated with 17 beta estradiol in the presence or absence of tamoxifen, Ici 182,780, ERK, or Src inhibitors. After bile duct ligation, cholangiocyte proliferation was associated with a marked immunohistochemical nuclear positivity for phosphorylated (p)-ERK1/2, which was inhibited by in vivo treatment with tamoxifen or Ici 182,780. Protein expression of total and p-ERK1/2, and Shc in cholangiocytes isolated from BDL rats was markedly increased compared with controls and was inhibited by in vivo treatment with antiestrogens. In vitro, 17 beta estradiol-induced proliferation of isolated normal cholangiocyte was associated with increased (P.01) protein expression of p-ERK1/2, Src, and Shc. Specific inhibitors of ER (Ici 182,780), ERK (U0125), and Src (PP2) inhibited in vitro 17 beta estradiol-induced cholangiocyte proliferation. In conclusion, this study showed that estrogens induced cholangiocyte proliferation by activating the Src/Shc/ERK pathway. This might suggest that pharmacologic modulation of ER, ERK, and/or Src could be proposed for the treatment of human pathology characterized by dysregulation of cholangiocyte proliferation.

Published
2002

37. Observer agreement in endoscopic assessment of ulcerative colitis

Author

Orlandi F, Brunelli E, Feliciangeli G, Svegliati-Baroni G, Antonio Di Sario, Benedetti A, Guidarelli C, and Macarri G

Subjects
Male, Observer Variation, Humans, Reproducibility of Results, Colitis, Ulcerative, Female, Colonoscopy, Sensitivity and Specificity
Abstract

Colonoscopy is the investigation of choice to evaluate ulcerative colitis, but the reliability of the assessment of endoscopic signs is not clear.The aim of this study was to evaluate interobserver agreement for the identification of endoscopic lesions typical of ulcerative colitis, and the influence of training.Four experienced observers and 11 endoscopists under training assessed 49 still images selected from endoscopic video recordings.The agreement rate between experienced observers was excellent or good (k0.39) for recognition of 10 out of 14 signs or patterns (loss of vascular pattern, erythema, oedema, granular mucosa, blood, pseudopolyp, erosion, ulcer, normal pattern, severe activity), and was poor for pus, stricture, mild activity, moderate activity. The rates between endoscopists under training were excellent or good for 6 items (loss of vascular pattern, erythema, oedema, pseudopolyp, normal pattern, severe activity).Trained observers can reproducibly record most endoscopic signs of ulcerative colitis. A reliable overall scoring of severity should be based on a simple three-grading scale, i.e. normal pattern, moderate activity, severe activity. Acceptable agreement rates can be obtained by endoscopists under training on some well-defined endoscopic appearances.

Published
1998

39. Observation of the Muonic Decay, Ds+/--]mu+/-nu-mu

Author

Aoki, S., Baroni, G., Bisi, V., Breslin, A. C., Catanesi, M. G., Chiba, K., Davis, D. H., Diliberto, S., Esten, M. J., Gerke, C., Hoshino, K., Kazuno, M., Kobayashi, M., Kodama, K., Maeda, Y., Marzarichiesa, A., Mazzoni, M. A., Meddi, Franco, Minakawa, F., Miyanishi, M., Muciaccia, M. T., Nakamura, M., Nakazawa, K., Niu, K., Niwa, K., Poulard, G., Radicioni, E., Ramello, L., Romano, G., Rosa, Giovanni, Ruggieri, F., Sartori, M. S., Sasaki, H., Sato, Y., Sgarbi, C., Shibuya, H., Simone, S., Tajima, H., Tasaka, S., Tezuka, I., Tovee, D. N., Ushida, N., and Yanagisawa, Y.

Published
1993

41. Simulation of functional tricuspid regurgitation using an isolated porcine heart model

Author

Francesco Maisano, Taramasso, M., Guidotti, A., Redaelli, A., Fiore, G. B., Baroni, G., Patete, P., Alfieri, O., Maisano, F, Taramasso, M, Guidotti, A, Redaelli, A, Fiore, Gb, Baroni, G, Patete, P, and Alfieri, Ottavio

Subjects
Disease Models, Animal, Swine, Systole, Ventricular Function, Right, Animals, Tricuspid Valve, In Vitro Techniques, Tricuspid Valve Insufficiency
Abstract

BACKGROUND AND AIM OF THE STUDY: The results of tricuspid annuloplasty to treat functional tricuspid regurgitation (FTR) are sometimes suboptimal, and alternative techniques are needed. In the absence of reliable FTR models, and in an effort to minimize the need for animal experiments, a reproducible bench-model was developed of FTR, that allowed the simulation of the anatomic features of the condition. METHODS: A fresh porcine heart was mounted on a rigid support that was placed into a basin filled with saline; a closed circuit was then created with a centrifugal pump, equipped with connection tubes. The inflow tube of the pump conveyed saline from the basin to the pump; the outflow cannula was inserted through the pulmonary artery, across the pulmonary valve, into the right ventricle. The pump was activated to pressurize the right ventricle, thus inducing tricuspid valve regurgitation (TVR). The regurgitant flow through the valve was quantified using a flow-meter. Radiopaque markers were sutured to the head of each papillary muscle and to the tricuspid annulus, in order to trace the geometric changes of the tricuspid valve at increasing pump rates, using fluoroscopy. The efficacy of the bench-model was validated with 10 hearts. RESULTS: The TVR was increased proportionally with the right ventricular pressure (RVP) (TVR = 0.089xRVP - 1.515; R2 = 0.89). The increase in TVR was associated with increases in the annular-to-papillary muscles distance (APML) (TVR = 0.059xAPML - 2.94; R2 = 0.96), of the inter-papillary muscles distance (PMD) (TVR = 0.058xPMD - 8.58; R2 = 0.94), and of the triscuspid annular dilatation (TAD) (TVR = 0.05xTAD - 1.85; R2 = 0.89). Of these parameters, APML was the strongest predictor of TVR. CONCLUSION: The porcine heart bench model represents a reproducible system to simulate the physiopathology of FTR, and has the potential to serve as a complementary method for the evaluation of new 'in vitro' technologies and therapies for FTR

42. OBSERVATION OF A 2ND CHARMED PARTICLE PRODUCED BY A HIGH-ENERGY NEUTRINO AND DECAYING AFTER A FEW TIMES 10-13S

Author

Angelini, Carlo, Bagnaia, P, Baroni, G, Bartley, Jh, Bertrandcoremans, G, Bisi, V, Breslin, A, Burhop, Ehs, Carena, F, Casali, R, Ciapetti, G, Conversi, M, Davis, Dh, Diliberto, S, Ferrer, Ml, Franzinetti, C, Gamba, D, Godfrey, L, Keane, D, Lamanna, E, Marzari, A, Marzano, F, Moggi, V, Montwill, A, Nappi, A, Palazzicerrina, C, Pazzi, R, Petrera, S, Pierazzini, Gm, Romano, G, Romero, A, Sacton, J, Santonico, R, Sever, R, Stannard, Fr, Tolun, P, Tovee, Dn, Vilain, P, Wickens, Jh, and Wilquet, G.

Published
1979

43. OBSERVATION OF A LIKELY EXAMPLE OF DECAY OF A CHARMED PARTICLE PRODUCED IN A HIGH-ENERGY NEUTRINO INTERACTION

Author

Burhop, Ehs, Davis, Dh, Tovee, Dn, Petersen, D, Read, Al, Coremansbertrand, G, Sacton, J, Vilain, P, Breslin, A, Montwill, A, Roberts, Ma, Garbutt, Da, Stannard, Fr, Blaes, G, Klein, R, Schmitt, Fm, Baroni, G, Ceradini, F, Conversi, M, Federici, L, Ferrer, Mj, Gentile, Simonetta, Diliberto, S, Petrera, S, Romano, G, Santonico, R, Bassompierre, G, Jung, M, Kurtz, N, Paty, M, and Schneegans, M.

Published
1976

44. 1ST DIRECT OBSERVATION OF THE DECAY OF NEUTRAL CHARMED PARTICLES PRODUCED BY NEUTRINOS IN EMULSION

Author

Allasia, D, Angelini, Carlo, Bagnaia, P, Baroni, G, Bartley, Jh, Bertrandcoremans, G, Bisi, V, Breslin, A, Burhop, Ehs, Carena, F, Casali, R, Ciapetti, G, Conversi, M, Davis, Dh, Diliberto, S, Fantechi, R, Ferrer, Ml, Franzinetti, C, Gamba, D, Godfrey, L, Keane, D, Lamanna, E, Marzari, A, Marzano, F, Montwill, A, Nappi, A, Palazzicerrina, C, Pazzi, R, Petrera, S, Pierazzini, Gm, Romano, G, Romero, A, Sacton, J, Santonico, R, Sever, R, Stannard, Fr, Tolun, P, Tovee, Dn, Vilain, P, Wickens, Jh, and Wilquet, G.

Published
1979

45. LIFETIME OF CHARGED CHARMED PARTICLES 1ST DIRECT OBSERVATION OF A CHARMED BARYON DECAY

Author

Angelini, Carlo, Bagnaia, P, Baroni, G, Bartley, Jh, Bertrandcoremans, G, Bisi, V, Breslin, A, Burhop, Ehs, Carena, F, Casali, R, Ciapetti, G, Conversi, M, Davis, Dh, Diliberto, S, Ferrer, Ml, Franzinetti, C, Gamba, D, Godfrey, L, Keane, D, Lamanna, E, Marzari, A, Marzano, F, Montwill, A, Morganti, R, Nappi, A, Palazzicerrina, C, Pazzi, R, Petrera, S, Pierazzini, Gm, Riccati, L, Romano, G, Romero, A, Sacton, J, Santonico, R, Sever, R, Stannard, Fr, Tolun, P, Tovee, Dn, Vilain, P, Wickens, Jh, and Wilquet, G.

Published
1979

47. [Controlled trial of a prostaglandin-inhibiting, non-steroid, anti-inflammatory drug in primary dysmenorrhea]

Author

Marino, L, Baroni, G, Riccardi, A, and Franchi, Massimo Piergiuseppe

Subjects
non-steroid, Adult, Thiazoles, [Controlled trial of a prostaglandin-inhibiting, Dysmenorrhea, Prostaglandin Antagonists, Anti-Inflammatory Agents, Humans, Female, [Controlled trial of a prostaglandin-inhibiting, non-steroid, anti-inflammatory drug in primary dysmenorrhea], Acetates, anti-inflammatory drug in primary dysmenorrhea]
Published
1982

50. ENTECAVIR EFFECTIVENESS IN DAILY CLINICAL PRACTICE, INTERIM ANALYSIS OF THE ITALIAN Master-Entas COHORT STUDY OF PATIENTS WITH CHRONIC HEPATITIS B

Author

Giuberti, T., Fasano, M., Brancaccio, G., Santantonio, T., Grasso, A., Marzano, A., Fabrizio Bronte, Maimone, S., Fagiuoli, S., Caporaso, N., Petrelli, E., Baroni, G. Svegliati, Labbadia, G., Verucchi, G., Niro, G. A., Pinzello, G. B., Montineri, A., Vinelli, F., Massari, M., Nosotti, L., Picardi, A., Missale, G., and Master-Entas Study, Grp

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