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1. 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

2. The changing scenario of hepatocellular carcinoma over the last two decades in Italy

Author

Santi V, Buccione D, Di Micoli A, Fatti G, Farinati F, Del Poggio P, Rapaccini G, Di Nolfo MA, Benvegnù L, Borzio F, Giannini EG, Caturelli E, Chiaramonte M, for the I.T.A. L.I. CA Group, FRIGERIO, MARTA, ZOLI, MARCO, BERNARDI, MAURO, TREVISANI, FRANCO, Santi V, Buccione D, Di Micoli A, Fatti G, Frigerio M, Farinati F, Del Poggio P, Rapaccini G, Di Nolfo MA, Benvegnù L, Zoli M, Borzio F, Giannini EG, Caturelli E, Chiaramonte M, Bernardi M, Trevisani F, and for the ITA.LI.CA Group.

Subjects
Male, medicine.medical_specialty, Pediatrics, Carcinoma, Hepatocellular, Databases, Factual, Survival, Hepatocellular carcinoma, Epidemiology, medicine.medical_treatment, Kaplan-Meier Estimate, Gastroenterology, Cirrhosis, Surveillance, Treatment, Primary sclerosing cholangitis, Liver disease, Internal medicine, Humans, Medicine, Aged, Retrospective Studies, Hepatology, business.industry, Liver Neoplasms, Retrospective cohort study, Middle Aged, medicine.disease, Italy, Female, Hepatitis D virus, Liver function, Percutaneous ethanol injection, business, Liver cancer
Abstract

BACKGROUND & AIMS: This study investigates whether the aetiologic changes in liver disease and the improved management of hepatocellular carcinoma (HCC) have modified the clinical scenario of this tumour over the last 20 years in Italy. METHODS: Retrospective study based on the analysis of the ITA.LI.CA (Italian Liver Cancer) database including 3027 HCC patients managed in 11 centres. Patients were divided into 3 groups according to the period of HCC diagnosis: 1987-1996 (year of the "Milano criteria" publication), 1997-2001 (year of release of the EASL guidelines for HCC), and 2002-2008. RESULTS: The significant changes were: (1) progressive patient ageing; (2) increasing prevalence of HCV infection until 2001, with a subsequent decrease, when the alcoholic aetiology increased; (3) liver function improvement, until 2001; (4) increasing "incidental" at the expense of "symptomatic" diagnoses, until 2001; (5) unchanged prevalence of tumours diagnosed during surveillance (around 50%), with an increasing use of the 6-month schedule; (6) favourable HCC "stage migration", until 2001; (7) increasing use of percutaneous ablation; (8) improving survival, until 2001. CONCLUSIONS: Over the last 20 years, several aetiologic and clinical features regarding HCC have changed. The survival improvement observed until 2001 was due to an increasing number of tumours diagnosed in early stages and in a background of compensated cirrhosis, and a growing and better use of locoregional treatments. However, the prevalence of early cancers and survival did not increase further in the last years, a result inciting national policies aimed at implementing surveillance programmes for at risk patients.

Published
2012

3. Cost-effectiveness of semi-annual surveillance for hepatocellular carcinoma in cirrhotic patients of the Italian Liver Cancer population

Author

CUCCHETTI, ALESSANDRO, TREVISANI, FRANCO, CESCON, MATTEO, ERCOLANI, GIORGIO, ZOLI, MARCO, PINNA, ANTONIO DANIELE, GRAMENZI, ANNAGIULIA, Farinati F., Poggio P. D., Rapaccini G., Nolfo M. A., Benvegnù L., Borzio F., Giannini E. G., Caturelli E., Chiaramonte M., BERNARDI, MAURO, Buccione D., CARACENI, PAOLO, Domenicali M., Erroi V., Fatti G., Frigerio M., Santi V., Magalotti D., Balsamo C., DI MARCO, MARIACRISTINA, Vavassori E., Gilardoni L., Mattiello M., Alberti A., Gatta A., Gios M., Cazzagon N., Giacomin A., Pozzan C., Sergio A., Vanin V., Giampalma E., Golfieri R., Mosconi C., Renzulli M., Ghittoni G., Roselli P., Bodini G., Corbo M., Savarino V., DOMENICALI, MARCO, Cucchetti A., Trevisani F., Cescon M., Ercolani G., Farinati F., Poggio P.D., Rapaccini G., Nolfo M.A., Benvegnù L., Zoli M., Borzio F., Giannini E.G., Caturelli E., Chiaramonte M., Pinna A.D., Bernardi M., Buccione D., Caraceni P., Domenicali M., Erroi V., Fatti G., Frigerio M., Gramenzi A., Santi V., Magalotti D., Balsamo C., Di Marco M., Vavassori E., Gilardoni L., Mattiello M., Alberti A., Gatta A., Gios M., Cazzagon N., Giacomin A., Pozzan C., Sergio A., Vanin V., Giampalma E., Golfieri R., Mosconi C., Renzulli M., Ghittoni G., Roselli P., Bodini G., Corbo M., and Savarino V.

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cost effectiveness, Cost-Benefit Analysis, medicine.medical_treatment, Population, COST-EFFECTIVENESS ANALYSIS, Liver transplantation, Risk Factors, Internal medicine, SURVEILLANCE, medicine, Humans, HEPATOCELLULAR CARCINOMA, Intensive care medicine, education, Survival rate, CIRRHOSIS, Aged, Aged, 80 and over, education.field_of_study, Hepatology, Relative survival, business.industry, Incidence, Liver Neoplasms, Odds ratio, Middle Aged, Prognosis, medicine.disease, Markov Chains, Survival Rate, Italy, Population Surveillance, Female, business, Liver cancer, Incremental cost-effectiveness ratio
Abstract

BACKGROUND AND AIMS: It was recently shown that semi-annual surveillance for hepatocellular carcinoma (HCC) in cirrhotic patients provides a prognostic advantage over the annual program; however, its cost-effectiveness (CE) in the general cirrhotic population still needs to be defined. METHODS: A Markov model was built to compare CE of these two strategies, considering literature results and treatment modalities of 918 cirrhotic patients from the Italian Liver Cancer (ITA.LI.CA) database. RESULTS: Results from the Markov model suggest that, compared to annual surveillance, semi-annual surveillance leads to a gain in quality-adjusted life expectancy, in an unselected cirrhotic population, of 1.35 quality-adjusted life-months (QALMs) over 10 years since surveillance start in compensated patients, and of 0.73 QALMs in decompensated patients. Semi-annual surveillance was more cost-effective in compensated than in decompensated cirrhosis, with an incremental CE ratio (ICER) of 1997 and 3814€/QALM, respectively. In compensated cirrhosis, semi-annual surveillance was more cost-effective than the annual program when the annual HCC incidence was ≥3.2% and the relative survival gain after cancer diagnosis was ≥20% with respect to the annual program. In decompensated cirrhosis, semi-annual surveillance was cost-effective in patients amenable to liver transplantation. In both groups, CE of semi-annual surveillance improved with the increase of annual incidence and the survival benefit obtainable with HCC treatment. CONCLUSIONS: Both surveillance strategies for HCC in cirrhotic patients can be recommended, according to the individual risk profile for HCC occurrence and the expected survival gain obtainable after tumor diagnosis and therapy.

Published
2012

4. Liver transplantation for hepatocellular carcinoma in clinical practice: the lesson from a 20-year multicentre experience in Italy

Author

Farinati Fabio, Giacomin Anna, Vanin Veronica, Sergio Adriana, Burra Patrizia, Cillo Umberto, Di Nolfo Annamaria, Del Poggio Paolo, Benvegnu Luisa, Zoli Marco, Borzio Franco, Giannini Edoardo, Caturelli Eugenio, Cazzagon Nora, Rapaccini Gian Ludovico, Trevisani Franco, for the Italian Liver Cancer (ITA. LI. CA) group, Andreone P, Bernardi M, Biselli M, Caraceni P, di Micoli A, Domenicali M, Magalotti D, Cappa FM, Santi V, Zambruni A, Balsamo C, Di Marco M, Vavassori E, Gilardoni L, Mattiello M, Alberti A, Gatta A, Gios M, Molaro M, Sala M, Savarino V, Risso D, Ghittoni G, Roselli P, Grazi GL, Nardo B, Ravaioli M, Pinna AD, Giampalma E, Golfieri R, Farinati Fabio, Giacomin Anna, Vanin Veronica, Sergio Adriana, Burra Patrizia, Cillo Umberto, Di Nolfo Annamaria, Del Poggio Paolo, Benvegnu Luisa, Zoli Marco, Borzio Franco, Giannini Edoardo, Caturelli Eugenio, Cazzagon Nora, Rapaccini Gian Ludovico, Trevisani Franco, for the Italian Liver Cancer (ITA.LI.CA) group [.., Andreone P, Bernardi M, Biselli M, Caraceni P, di Micoli A, Domenicali M, Magalotti D, Cappa FM, Santi V, Zambruni A, Balsamo C, Di Marco M, Vavassori E, Gilardoni L, Mattiello M, Alberti A, Gatta A, Gios M, Molaro M, Sala M, Savarino V, Risso D, Ghittoni G, Roselli P, Grazi GL, Nardo B, Ravaioli M, Pinna AD, Giampalma E, Golfieri R, and ]

Subjects
Male, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Liver transplantation, Guideline, Gastroenterology, Internal medicine, Carcinoma, Medicine, Humans, guidelines, neoplasms, Selection (genetic algorithm), Aged, Hepatology, business.industry, General surgery, HEPATOCELLULAR CARCINOMA, LIVER TRANSPLANTATION, Guidelines, Evidence-based approach, Patient Selection, Liver Neoplasms, hepatocellular carcinoma, evidence-based approach, liver transplantation, Middle Aged, medicine.disease, Prognosis, digestive system diseases, Liver Transplantation, Neoplasm Proteins, Clinical Practice, Transplantation, Treatment Outcome, Italy, Hepatocellular carcinoma, Practice Guidelines as Topic, Female, Guideline Adherence, alpha-Fetoproteins, business, Epidemiologic Methods
Abstract

INTRODUCTION: Hepatocellular carcinoma (HCC) is an established indication for liver transplantation (LT), but the selection criteria and priority are still debated. AIMS: To ascertain the number and features of patients with HCC who undergo transplantation in a Western country, the number of patients eligible for LT according to the American Association for the Study of Liver Diseases (AASLD) guidelines, the number of patients who actually undergo transplantation and whether adherence affects survival. METHODS: This is a retrospective analysis from a multicentre Italian database of 2042 cases of HCC, recruited prospectively and consecutively. Kaplan-Meier (log rank) and Cox multivariate analysis estimated survival. RESULTS: Patients who had undergone transplantation (50, 2.5%, with no change over time) had a median survival of 133 months, significantly influenced by the number of lesions and alpha-fetoprotein levels, which were found to be independent predictors of survival on multivariate analysis. Milan criteria were fulfilled in 68%, impacting on survival, whereas 48% fulfilled AASLD guidelines, without such an impact. Two hundred and twenty-eight (11%) patients were eligible for LT according to AASLD; in this group, alpha-fetoprotein levels and Child-Pugh class were independent predictors of survival. CONCLUSION: Among patients with HCC, those undergoing LT represent a small minority; even fewer (1%) are those who undergo transplantation according to AASLD guidelines, adherence to which only marginally affects survival. Overall, LT impact on HCC patients' treatment is very limited

Published
2011

5. Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20 year multicentre experience

Author

MIRICI CAPPA, FEDERICA, GRAMENZI, ANNAGIULIA, ZAMBRUNI, ANDREA, DI MICOLI, ANTONIO, FRIGERIO, MARTA, ZOLI, MARCO, BERNARDI, MAURO, TREVISANI, FRANCO, Santi V, Maraldi F, Di Nolfo MA, Del Poggio P, Benvegnù L, Rapaccini G, Farinati F, Borzio F, Giannini EG, Caturelli E, for the Italian Liver Cancer group, Mirici-Cappa F, Gramenzi A, Santi V, Zambruni A, Di Micoli A, Frigerio M, Maraldi F, Di Nolfo MA, Del Poggio P, Benvegnù L, Rapaccini G, Farinati F, Zoli M, Borzio F, Giannini EG, Caturelli E, Bernardi M, Trevisani F, and for the Italian Liver Cancer (ITA.LI.CA.) group.

Subjects
Male, medicine.medical_specialty, Percutaneous, Cirrhosis, Carcinoma, Hepatocellular, Population, Internal medicine, medicine, Hepatectomy, Humans, HEPATOCELLULAR CARCINOMA, Chemoembolization, Therapeutic, education, Aged, education.field_of_study, ELDERLY, business.industry, Liver Neoplasms, Gastroenterology, Age Factors, Cancer, CANCER STAGE, Retrospective cohort study, TREATMENT, Middle Aged, medicine.disease, Prognosis, Surgery, Treatment Outcome, Hepatocellular carcinoma, Propensity score matching, Catheter Ablation, SURVIVAL, Female, Liver function, business, Epidemiologic Methods
Abstract

Objectives The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is expected to increase. We compared the presenting features and outcome of HCC in elderly (≥70 years) and younger patients ( Design Multicentre retrospective cohort study and nested case–control study. Patients 614 elderly and 1104 younger patients from the ITA.LI.CA database, including 1834 HCC cases consecutively diagnosed from January 1987 to December 2004. Both groups were stratified according to treatment: hepatic resection, percutaneous procedures, transarterial chemoembolisation (TACE). Survival was assessed in the whole population and in each treatment subgroup. Age, sex, aetiology, cirrhosis, comorbidities and cancer stage (CLIP score) were tested as predictors of survival. In each subgroup, differences in patient survival were also assessed after adjustment and matching by propensity score. Results Ageing was associated with a higher prevalence of comorbidities, better liver function and CLIP score. Regardless of age, two-thirds of patients underwent radical treatments or TACE. Elderly patients underwent more ablative procedures and fewer resections or TACE sessions. The survival of elderly and younger patients was comparable in each treatment subset, and was predicted by CLIP score. This result was confirmed by the propensity analysis. Conclusions The overall applicability of radical or effective HCC treatments was unaffected by old age. However, treatment distribution differed, elderly individuals being more frequently treated with percutaneous procedures and less frequently with resection or TACE. Survival was unaffected by age and primarily predicted by cancer stage, assessed by the CLIP system, both in the overall population and in treatment subgroups.

Published
2010

6. Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival

Author

Santi, V, Del Poggio, P, Di Nolfo, MA, Benvegnù, L, Farinati, F, Giannini, EG, Borzio, F, Caturelli, E, Chiaramonte, M, Italian Liver Cancer Group, DOMENICALI, MARCO, TREVISANI, FRANCO, GRAMENZI, ANNAGIULIA, GRIGNASCHI, ALICE, MIRICI CAPPA, FEDERICA, ZOLI, MARCO, BERNARDI, MAURO, Santi, V, Trevisani, F, Gramenzi, A, Grignaschi, A, Mirici Cappa, F, Del Poggio, P, Di Nolfo, MA, Benvegnù, L, Farinati, F, Zoli, M, Giannini, EG, Borzio, F, Caturelli, E, Chiaramonte, M, Bernardi, M, and Italian Liver Cancer (ITA.LI.CA) Group.

Subjects
Liver Cirrhosis, Male, Cirrhosis, Cost effectiveness, medicine.medical_treatment, RADIOFREQUENCY THERMAL ABLATION, Gastroenterology, COST-EFFECTIVENESS, Liver disease, PERCUTANEOUS ETHANOL INJECTION, RADIOFREQUENCY THERMAL ABLATION, CIRRHOTIC-PATIENTS, COST-EFFECTIVENESS, EARLY-DIAGNOSIS, LIVER-DISEASE, RISK-FACTORS, EXPERIENCE, MANAGEMENT, RESECTION, CIRRHOSIS, Ultrasonography, Aged, 80 and over, Liver Neoplasms, CANCER STAGE, SURVEILLANCE INTERVAL, Middle Aged, Prognosis, Survival Rate, Italy, Liver, Population Surveillance, Hepatocellular carcinoma, Disease Progression, SURVIVAL, CIRRHOTIC-PATIENTS, Female, Adult, medicine.medical_specialty, RESECTION, Carcinoma, Hepatocellular, LIVER-DISEASE, Internal medicine, MANAGEMENT, medicine, Humans, Early Hepatocellular Carcinoma, HEPATOCELLULAR CARCINOMA, Aged, Hepatology, business.industry, Cancer, EARLY-DIAGNOSIS, medicine.disease, Confidence interval, RISK-FACTORS, EXPERIENCE, PERCUTANEOUS ETHANOL INJECTION, Percutaneous ethanol injection, business
Abstract

The current guidelines recommend the surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on liver ultrasonography repetition at either 6 or 12 month intervals, since there is no compelling evidence of superiority of the more stringent program. This study aimed at comparing cancer stage, treatment applicability, and survival between patients on semiannual or annual surveillance.We analyzed the clinical records of 649 HCC patients in Child-Pugh class A or B, observed in ITA.LI.CA centers. HCC was detected in 510 patients submitted to semiannual surveillance (Group 1) and in 139 submitted to annual surveillance (Group 2). In Group 1 the survival was presented as observed and corrected for the lead time.The cancer stage was less severe in Group 1 than in Group 2 (p0.001), with more single tiny (2 cm) and less advanced tumors. Treatment applicability was improved by the semiannual program (p=0.020). The median observed survival was 45 months (95% CI 40.0-50.0) in Group 1 and 30 months (95% CI 24.0-36.0) in Group 2 (p=0.001). The median corrected survival of Group 1 was 40.3 months (95% CI 34.9-45.7) (p=0.028 with respect to the observed survival of Group 2). Age, platelet count, alpha-fetoprotein, Child-Pugh class, cancer stage, and hepatocellular carcinoma treatment were independent prognostic factors.Semiannual surveillance increases the detection rate of very early hepatocellular carcinomas and reduces the number of advanced tumors as compared to the annual program. This translates into a greater applicability of effective treatments and into a better prognosis.

Published
2010

7. Hepatocellular carcinoma in patients with cryptogenic cirrhosis

Author

Edoardo Giovanni Giannini, Elisa Marabotto, Vincenzo Savarino, Maria Anna di Nolfo, Paolo Del Poggio∥, Luisa Benvegnù, Fabio Farinati, Franco Borzio, Eugenio Caturelli, Maria Chiaramonte, Italian Liver Cancer Group [. . ., Cursaro C., Di Micoli A., Frigerio M., Cappa F. M., Santi V., Zambruni A., GRAZI, GIAN LUCA, Ravaioli M., Giampalma E., Di Marco M., Vavassori E., Gilardoni L., Mattiello M., Alberti A., Gatta A., Gios M., De Giorgio M., Gianni S., Rinaldi M., Roselli P., Ghittoni G., TREVISANI, FRANCO, ZOLI, MARCO, ANDREONE, PIETRO, BERNARDI, MAURO, CARACENI, PAOLO, DOMENICALI, MARCO, GRAMENZI, ANNAGIULIA, NARDO, BRUNO, GOLFIERI, RITA, Edoardo Giovanni Giannini, Elisa Marabotto, Vincenzo Savarino, Franco Trevisani, Maria Anna di Nolfo, Paolo Del Poggio∥, Luisa Benvegnù, Fabio Farinati, Marco Zoli, Franco Borzio, Eugenio Caturelli, Maria Chiaramonte, Italian Liver Cancer (ITALICA) Group [.., Andreone P., Bernardi M., Caraceni P., Cursaro C., Di Micoli A., Domenicali M., Gramenzi A., Frigerio M., Cappa F.M., Santi V., Zambruni A., Grazi G.L., Nardo B., Ravaioli M., Giampalma E., Golfieri R., Di Marco M., Vavassori E., Gilardoni L., Mattiello M., Alberti A., Gatta A., Gios M., De Giorgio M., Gianni S., Rinaldi M., Roselli P., Ghittoni G., and ]

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, HEPATOCELLULAR CARCINOMA, CRYPTOGENIC CIRRHOSIS, Hepatitis C virus, medicine.disease_cause, Gastroenterology, Internal medicine, medicine, Carcinoma, Humans, Transaminases, Aged, Hepatitis, Chronic, Hepatitis B virus, Hepatitis, Aged, 80 and over, Hepatology, business.industry, Platelet Count, Middle Aged, medicine.disease, digestive system diseases, Cryptogenic cirrhosis, Hepatocellular carcinoma, Female, Liver function, business, Liver cancer
Abstract

BACKGROUND & AIMS: Patients with cryptogenic cirrhosis (CC) can develop hepatocellular carcinoma (HCC), although the clinical characteristics of HCC in these patients have not been completely defined. We aimed to characterize the clinical features of patients diagnosed with HCC after CC during a 15-year period (1992-2006). METHODS: The clinical characteristics of 45 consecutive CC patients with HCC were analyzed, along with modality of diagnosis, tumor stage, treatment, survival, and causes of death. Data were compared with those of 426 consecutive patients with HCC and only hepatitis C virus (HCV) infection, diagnosed during the same period at the Italian Liver Cancer group centers. RESULTS: HCC patients with CC had similar impairments in liver function as patients with HCV infection (Child-Pugh class A: 53% vs 65%; P = .141). However, the HCC patients with CC had lower aminotransferase levels (P < .001) and higher platelet counts (P < .001). HCC was significantly less likely to be diagnosed during surveillance in CC patients (29% vs 64%; P < .0001). Patients with CC had a significantly greater prevalence of advanced HCC stage, according to Milano criteria (69% vs 41%; P < .0005), larger HCC size (4.9 vs 3.0 cm; P = .0001), lower amenability to any treatment (27% vs 42%; P = .036), and shorter survival times (P = .009, log-rank test) compared with HCV patients. Causes of death were similar in the 2 groups. CONCLUSIONS: Compared with HCV patients, HCC in CC patients often is diagnosed at an advanced stage, probably owing to lack of surveillance; this leads to limited treatment options and shorter survival times.

Published
2009

8. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma

Author

Golfieri, R., Giampalma, E., Renzulli, M, Cioni, R., Bargellini, I., Bartolozzi, C., Breatta, A. D., Gandini, G., Nani, R., Gasparini, D., Cucchetti, A., Bolondi, L., Trevisani, COLLABORATORS:Mosconi C, F., Cappelli, A, Galaverni, Mc, Pini, P, Piscaglia, F, Benevento, F, Giampaolo, L, Caprara, C, Menichella, R, Lenzi, M, Bernardi, M, Santi, V, Erroi, V, Mazzella, G, Colecchia, A, Montrone, L, Schiumerini, R, Bianchi, G, Zoli, M, Martini, G, Fraticelli, L, Sama, C, Berardi, S, Serra, C, Vignali, C, Bianchi, F, Vallini, V, Carrai, P, Filipponi, F, Moneta, S, Pea, E, Giunta, S, Sacco, R, Ricchiuti, A, di Fluri, G, Coco, B, Rossato, D, Vighetti, C, Battisti, G, Rapellino, A, Carucci, P, Cosso, L, Rizzetto, M, Mirabella, S, Sturniolo, L, Catalano, Giorgia, Salizzoni, M, Agazzi, R, Limonta, S, Fagiuoli, S, Verga, G, Magini, G, Aprile, G, Vit, A., Golfieri, R, Giampalma, E, Renzulli, M, Cioni, R, Bargellini, I, Bartolozzi, C, Breatta, A, Gandini, G, Nani, R, Gasparini, D, Cucchetti, A, Bolondi, L, Trevisani, F, Fagiuoli, S, Golfieri, Rita, Giampalma, Emanuela, Renzulli, Matteo, Cioni, R., Bargellini, I., Bartolozzi, Catia, Breatta, A. D., Gandini, Gualtiero, Nani, R., Gasparini, D., Cucchetti, Alessandro, Bolondi, Luigi, Trevisani, Franco, on behalf of the PRECISION ITALIA STUDY GROUP:, [. . ., Piscaglia, Fabio, Bernardi, Mauro, IBARRA GASPARINI, Daniela, and ], . .

Subjects
Male, medicine.medical_specialty, Abdominal pain, Cancer Research, Carcinoma, Hepatocellular, intra-arterial hepatic therapy, mRECIST, Gastroenterology, survival, law.invention, liver cancer, Randomized controlled trial, law, Antibiotics, Internal medicine, medicine, Carcinoma, Humans, Prospective Studies, HEPATOCELLULAR CARCINOMA, Chemoembolization, Therapeutic, Adverse effect, Prospective cohort study, Survival rate, Aged, Antibiotics, Antineoplastic, business.industry, Liver Neoplasms, Hepatocellular, medicine.disease, Doxorubicin, Female, Survival Rate, Oncology, Antineoplastic, Surgery, Hepatocellular carcinoma, Clinical Study, Chemoembolization, medicine.symptom, Therapeutic, Liver cancer, business
Abstract

Background: Transcatheter arterial chemoembolisation (TACE) is the treatment of choice for intermediate stage hepatocellular carcinoma (HCC). Doxorubicin-loaded drug-eluting beads (DEB)-TACE is expected to improve the performance of conventional TACE (cTACE). The aim of this study was to compare DEB-TACE with cTACE in terms of time-to-tumour progression (TTP), adverse events (AEs), and 2-year survival. Methods: Patients were randomised one-to-one to undergo cTACE or DEB-TACE and followed-up for at least 2 years or until death. Transcatheter arterial chemoembolisation was repeated ‘on-demand'. Results: We enrolled 177 patients: 89 underwent DEB-TACE and 88 cTACE. The median number of procedures was 2 in each arm, and the in-hospital stay was 3 and 4 days, respectively (P=0.323). No differences were found in local and overall tumour response. The median TTP was 9 months in both arms. The AE incidence and severity did not differ between the arms, except for post-procedural pain, more frequent and severe after cTACE (P

Published
2014

9. Effects of the combined treatment with thalidomide and megestrol in cirrhotic patients with advanced hepatocellular carcinoma. A pilot study

Author

MIRICI CAPPA, FEDERICA, CANTARINI, MARIA CHIARA, MAGINI, GIULIA, ZAMBRUNI, ANDREA, BERNARDI, MAURO, TREVISANI, FRANCO, Bendini C., Santi V., Mirici Cappa F., Cantarini M.C., Magini G., Zambruni A., Bendini C., Santi V., Bernardi M., and Trevisani F.

Subjects
MEGESTROL, THALIDOMIDE, HEPATOCELLULAR CARCINOMA, CIRRHOSIS, INTERLEUKIN-2
Published
2005

10. Effects of the combined treatment with thalidomide, megestrol and interleukine-2 in cirrhotic patients with advanced hepatocellular carcinoma: A pilot study.

Author

Cappa, F. Mirici, Cantarini, M.C., Magini, G., Zambruni, A., Bendini, C., Santi, V., Bernardi, M., and Trevisani, F.

Subjects
CANCER patients, LIVER cancer, INTERLEUKIN-2, THALIDOMIDE
Abstract

Abstract: Background.: Thalidomide, an anti-angiogenic agent, does not have a good therapeutic effect for advanced hepatocellular carcinoma when used alone. Megestrol and interleukin-2 have been proposed as a palliative treatment for hepatocellular carcinoma. Aims.: We assessed the effectiveness/safety of a combined therapy with thalidomide+megestrol+interleukin-2 in cirrhotic patients with advanced hepatocellular carcinoma. Patients and methods.: Nine cirrhotic patients with advanced hepatocellular carcinoma received oral megestrol (160mg/day) and thalidomide (from 50mg/day to the maximal tolerated dose). Four patients also received subcutaneous interleukin-2 (1 million U/day for 21 days/month). Results.: The maximal tolerated dose of thalidomide was 150mg/day. All patients complained of sedation and other neurological or digestive adverse effects. In all but one patient the adverse effects disappeared after thalidomide withdrawal or dose reduction. Interleukin-2 administration caused a flu-like syndrome and a reaction at the injection site. During treatment, alpha-fetoprotein increased in six patients, remained stable in two and decreased in one. Eight patients showed tumour progression and one had a stable disease. Eight patients died. The median survival was 9.9 (range 2.6–18.6) months. Conclusion.: In cirrhotic patients, the combined treatment with thalidomide+megestrol (±interleukin-2) does not control hepatocellular carcinoma growth, possibly due to the low tolerance to thalidomide and interleukin-2 preventing the use of appropriate dosages. [Copyright &y& Elsevier]

Published
2005
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11. Potential feasibility of atezolizumab-bevacizumab therapy in patients with hepatocellular carcinoma treated with tyrosine-kinase inhibitors

Author

Benedetta Stefanini, Laura Bucci, Valentina Santi, Nicola Reggidori, Davide Rampoldi, Lorenzo Lani, Alessandro Granito, Angelo Sangiovanni, Giuseppe Cabibbo, Fabio Farinati, Claudia Campani, Francesco Giuseppe Foschi, Gianluca Svegliati-Baroni, Giovanni Raimondo, Antonio Gasbarrini, Andrea Mega, Elisabetta Biasini, Rodolfo Sacco, Filomena Morisco, Eugenio Caturelli, Gianpaolo Vidili, Francesco Azzaroli, Edoardo G. Giannini, Gian Ludovico Rapaccini, Maurizia Rossana Brunetto, Alberto Masotto, Gerardo Nardone, Mariella Di Marco, Donatella Magalotti, Franco Trevisani, Maurizio Biselli, Paolo Caraceni, Annagiulia Gramenzi, Francesco Tovoli, Luca Muratori, Francesca Benevento, Gloria Allegrini, Calogero Cammà, Ciro Celsa, Paolo Giuffrida, Caterina Stornello, Mauro Grova, Carmelo Marco Giacchetto, Gabriele Rancatore, Maria Vittoria Grassini, Valentina Adotti, Stefano Gitto, Fabio Marra, Martina Rosi, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Anna Chiara Dall'Aglio, Giorgio Ercolani, Federica Mirici, Nicoletta de Matthaeis, Francesca Romana Ponziani, Gabriele Missale, Andrea Olivani, Maria Guarino, Valentina Cossiga, Mario Capasso, Ester Marina Cela, Antonio Facciorusso, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Serena Dell'Isola, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Elton Dajti, Federico Ravaioli, Giulia Pieri, Maria Corina Plaz Torres, Filippo Oliveri, Gabriele Ricco, Veronica Romagnoli, Alessandro Inno, Fabiana Marchetti, Pietro Coccoli, Antonio Malerba, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, null Matteo Renzulli, Stefanini, B., Bucci, L., Santi, V., Reggidori, N., Rampoldi, D., Lani, L., Granito, A., Sangiovanni, A., Cabibbo, G., Farinati, F., Campani, C., Foschi, F. G., Svegliati-Baroni, G., Raimondo, G., Gasbarrini, A., Mega, A., Biasini, E., Sacco, R., Morisco, F., Caturelli, E., Vidili, G., Azzaroli, F., Giannini, E. G., Rapaccini, G. L., Brunetto, M. R., Masotto, A., Nardone, G., Di Marco, M., Magalotti, D., Trevisani, F., Biselli, M., Caraceni, P., Gramenzi, A., Tovoli, F., Muratori, L., Benevento, F., Allegrini, G., Camma, C., Celsa, C., Giuffrida, P., Stornello, C., Grova, M., Giacchetto, C. M., Rancatore, G., Grassini, M. V., Adotti, V., Gitto, S., Marra, F., Rosi, M., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Dall'Aglio, A. C., Ercolani, G., Mirici, F., de Matthaeis, N., Ponziani, F. R., Missale, G., Olivani, A., Guarino, M., Cossiga, V., Capasso, M., Cela, E. M., Facciorusso, A., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Dell'Isola, S., Franze, M. S., Saitta, C., Sauchella, A., Dajti, E., Ravaioli, F., Pieri, G., Torres, M. C. P., Oliveri, F., Ricco, G., Romagnoli, V., Inno, A., Marchetti, F., Coccoli, P., Malerba, A., Cappelli, A., Golfieri, R., Mosconi, C., Matteo, Renzulli, Stefanini, Benedetta, Bucci, Laura, Santi, Valentina, Reggidori, Nicola, Rampoldi, Davide, Lani, Lorenzo, Granito, Alessandro, Sangiovanni, Angelo, Cabibbo, Giuseppe, Farinati, Fabio, Campani, Claudia, Foschi, Francesco Giuseppe, Svegliati-Baroni, Gianluca, Raimondo, Giovanni, Gasbarrini, Antonio, Mega, Andrea, Biasini, Elisabetta, Sacco, Rodolfo, Morisco, Filomena, Caturelli, Eugenio, Vidili, Gianpaolo, Azzaroli, Francesco, Giannini, Edoardo G, Rapaccini, Gian Ludovico, Brunetto, Maurizia Rossana, Masotto, Alberto, Nardone, Gerardo, Di Marco, Mariella, Magalotti, Donatella, and Trevisani, Franco

Subjects
Atezolizumab-bevacizumab, Clinical Trials as Topic, Antineoplastic Combined Chemotherapy Protocol, Carcinoma, Hepatocellular, Systemic therapy, Hepatology, Hepatocellular carcinoma, Tirosin-kinase inhibitor, Liver Neoplasms, Gastroenterology, Bevacizumab, Feasibility Studie, Tyrosine, Human
Abstract

Background: The combination of atezolizumab-bevacizumab has been proven to be superior to sorafenib for the treatment of unresectable hepatocellular carcinoma not amenable to locoregional treatments, be-coming the standard of care of systemic therapy.Aim: This study aimed at assessing real-world feasibility of atezolizumab-bevacizumab in patients treated with tyrosine-kinase inhibitors.Methods: Among 1447 patients treated with tyrosine-kinase inhibitors from January 2010 to December 2020, we assessed the percentage of those potentially eligible to atezolizumab-bevacizumab (according to IMbrave-150 trial criteria), and the overall survival of eligible and non-eligible patients.Results: 422 (29%) patients were qualified for atezolizumab-bevacizumab therapy. The main exclusion causes were Child-Pugh class and Performance Status. Adopting the more permissive inclusion criteria of SHARP trial, 535 patients became eligible. The median overall survival of tyrosine-kinase inhibitors patients was 14.9 months, longer in eligible patients than in their counterpart due to better baseline liver function and oncological features.Conclusion: Real-world data indicate that less than one-third of hepatocellular carcinoma patients treated with tyrosine-kinase inhibitors are potentially eligible to atezolizumab-bevacizumab according to the reg-istration trial criteria. These patients have a longer survival than the non-eligible ones. If the selection criteria of atezolizumab-bevacizumab trial are maintained in clinical practice, tyrosine-kinase inhibitors will remain the most used systemic therapy for hepatocellular carcinoma patients.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Published
2022

12. Surveillance for hepatocellular carcinoma with a 3-months interval in 'extremely high-risk' patients does not further improve survival

Author

Filippo Pelizzaro, Giulia Peserico, Marco D'Elia, Nora Cazzagon, Francesco Paolo Russo, Alessandro Vitale, Edoardo G. Giannini, Manuela Piccinnu, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Giuseppe Cabibbo, Fabio Marra, Andrea Mega, Filomena Morisco, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Andrea Olivani, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Filippo Oliveri, Franco Trevisani, Fabio Farinati, Maurizio Biselli, Paolo Caraceni, Francesca Garuti, Annagiulia Gramenzi, Andrea Neri, Valentina Santi, Fabio Piscaglia, Francesco Tovoli, Alessandro Granito, Luca Muratori, Francesca Benevento, Elton Dajti, Giovanni Marasco, Federico Ravaioli, Alberta Cappelli, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Angela Imondi, Anna Sartori, Barbara Penzo, Elisa Pinto, Ester Marina Cela, Antonio Facciorusso, Valentina Cacciato, Edoardo Casagrande, Alessandro Moscatelli, Gaia Pellegatta, Nicoletta De Matthaeis, Gloria Allegrini, Valentina Lauria, Giorgia Ghittoni, Giorgio Pelecca, Fabrizio Chegai, Fabio Coratella, Mariano Ortenzi, Gabriele Missale, Alessandro Inno, Fabiana Marchetti, Anita Busacca, Calogero Cammà, Vincenzo Di Martino, Giacomo Emanuele Maria Rizzo, Maria Stella Franzè, Carlo Saitta, Assunta Sauchella, Vittoria Bevilacqua, Alberto Borghi, Andrea Casadei Gardini, Fabio Conti, Anna Chiara Dall'aglio, Giorgio Ercolani, Federica Mirici, Claudia Campani, Chiara Di Bonaventura, Stefano Gitto, Pietro Coccoli, Antonio Malerba, Maria Guarino, Maurizia Brunetto, Veronica Romagnoli, Pelizzaro, F., Peserico, G., D'Elia, M., Cazzagon, N., Russo, F. P., Vitale, A., Giannini, E. G., Piccinnu, M., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Sacco, R., Cabibbo, G., Marra, F., Mega, A., Morisco, F., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Olivani, A., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Farinati, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Santi, V., Piscaglia, F., Tovoli, F., Granito, A., Muratori, L., Benevento, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Imondi, A., Sartori, A., Penzo, B., Pinto, E., Cela, E. M., Facciorusso, A., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., De Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Missale, G., 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., Casadei Gardini, A., Conti, F., Dall'Aglio, A. C., Ercolani, G., Mirici, F., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Guarino, M., Brunetto, M., Romagnoli, V., Pelizzaro, Filippo, Peserico, Giulia, D'Elia, Marco, Cazzagon, Nora, Russo, Francesco Paolo, Vitale, Alessandro, Giannini, Edoardo G., Piccinnu, Manuela, Rapaccini, Gian Ludovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Sacco, Rodolfo, Cabibbo, Giuseppe, Marra, Fabio, Mega, Andrea, Morisco, Filomena, Gasbarrini, Antonio, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Raimondo, Giovanni, Azzaroli, Francesco, Vidili, Gianpaolo, Oliveri, Filippo, Trevisani, Franco, Farinati, Fabio, Biselli, Maurizio, Caraceni, Paolo, Garuti, Francesca, Gramenzi, Annagiulia, Neri, Andrea, Santi, Valentina, Piscaglia, Fabio, Tovoli, Francesco, Granito, Alessandro, Muratori, Luca, Benevento, Francesca, Dajti, Elton, Marasco, Giovanni, Ravaioli, Federico, Cappelli, Alberta, Golfieri, Rita, Mosconi, Cristina, Renzulli, Matteo, Imondi, Angela, Sartori, Anna, Penzo, Barbara, Pinto, Elisa, Cela, Ester Marina, Facciorusso, Antonio, Cacciato, Valentina, Casagrande, Edoardo, Moscatelli, Alessandro, Pellegatta, Gaia, De Matthaeis, Nicoletta, Allegrini, Gloria, Lauria, Valentina, Ghittoni, Giorgia, Pelecca, Giorgio, Chegai, Fabrizio, Coratella, Fabio, Ortenzi, Mariano, Missale, Gabriele, Inno, Alessandro, Marchetti, Fabiana, Busacca, Anita, Cammà, Calogero, Di Martino, Vincenzo, Rizzo, Giacomo Emanuele Maria, Franzè, Maria Stella, Saitta, Carlo, Sauchella, Assunta, Bevilacqua, Vittoria, Borghi, Alberto, Casadei Gardini, Andrea, Conti, Fabio, Dall'aglio, Anna Chiara, Ercolani, Giorgio, Mirici, Federica, Campani, Claudia, Di Bonaventura, Chiara, Gitto, Stefano, Coccoli, Pietro, Malerba, Antonio, Guarino, Maria, Brunetto, Maurizia, and Romagnoli, Veronica

Subjects
medicine.medical_specialty, Carcinoma, Hepatocellular, Survival, Hepatocellular carcinoma, Cancer stage, Surveillance interval, Internal medicine, medicine, Humans, Propensity Score, Survival analysis, High risk patients, Hepatology, business.industry, Liver Neoplasms, Settore MED/09 - MEDICINA INTERNA, Gastroenterology, Patient survival, medicine.disease, Survival Analysis, Propensity score matching, Survival Analysi, Liver cancer, business, Median survival, Human
Abstract

Background An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.

Published
2022

13. Monofocal hepatocellular carcinoma: How much does size matter?

Author

Pelizzaro, Filippo, Penzo, Barbara, Peserico, Giulia, Imondi, Angela, Sartori, Anna, Vitale, Alessandro, Cillo, Umberto, Giannini, Edoardo G., Forgione, Antonella, Ludovico Rapaccini, Gian, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Sacco, Rodolfo, Cabibbo, Giuseppe, Marra, Fabio, Mega, Andrea, Morisco, Filomena, Gasbarrini, Antonio, Svegliati‐Baroni, Gianluca, Giuseppe Foschi, Francesco, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Raimondo, Giovanni, Azzaroli, Francesco, Vidili, Gianpaolo, Oliveri, Filippo, Trevisani, Franco, Farinati, Fabio, Biselli, Maurizio, Caraceni, Paolo, Garuti, Francesca, Gramenzi, Annagiulia, Neri, Andrea, Santi, Valentina, Granito, Alessandro, Muratori, Luca, Piscaglia, Fabio, Sansone, Vito, Tovoli, Francesco, Dajti, Elton, Marasco, Giovanni, Ravaioli, Federico, Cappelli, Alberta, Golfieri, Rita, Mosconi, Cristina, Renzulli, Matteo, Sammarco, Ambra, Cela, Ester Marina, Facciorusso, Antonio, Cacciato, Valentina, Casagrande, Edoardo, Moscatelli, Alessandro, Pellegatta, Gaia, de Matthaeis, Nicoletta, Allegrini, Gloria, Lauria, Valentina, Ghittoni, Giorgia, Pelecca, Giorgio, Chegai, Fabrizio, Coratella, Fabio, Ortenzi, Mariano, Missale, Gabriele, Inno, Alessandro, Marchetti, Fabiana, Busacca, Anita, Cammà, Calogero, Martino, Vincenzo Di, Emanuele Maria Rizzo, Giacomo, Franzè, Maria Stella, Saitta, Carlo, Sauchella, Assunta, Bevilacqua, Vittoria, Borghi, Alberto, Casadei Gardini, Andrea, Conti, Fabio, Dall'Aglio, Anna Chiara, Ercolani, Giorgio, Mirici, Federica, Campani, Claudia, Bonaventura, Chiara Di, Gitto, Stefano, Coccoli, Pietro, Malerba, Antonio, Guarino, Maria, Brunetto, Maurizia, Romagnoli, Veronica, Pelizzaro, Filippo, Penzo, Barbara, Peserico, Giulia, Imondi, Angela, Sartori, Anna, Vitale, Alessandro, Cillo, Umberto, Giannini, Edoardo G., Forgione, Antonella, Ludovico Rapaccini, Gian, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Sacco, Rodolfo, Cabibbo, Giuseppe, Marra, Fabio, Mega, Andrea, Morisco, Filomena, Gasbarrini, Antonio, Svegliati‐Baroni, Gianluca, Giuseppe Foschi, Francesco, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Raimondo, Giovanni, Azzaroli, Francesco, Vidili, Gianpaolo, Oliveri, Filippo, Trevisani, Franco, Farinati, Fabio, Biselli, Maurizio, Caraceni, Paolo, Garuti, Francesca, Gramenzi, Annagiulia, Neri, Andrea, Santi, Valentina, Granito, Alessandro, Muratori, Luca, Piscaglia, Fabio, Sansone, Vito, Tovoli, Francesco, Dajti, Elton, Marasco, Giovanni, Ravaioli, Federico, Cappelli, Alberta, Golfieri, Rita, Mosconi, Cristina, Renzulli, Matteo, Sammarco, Ambra, Cela, Ester Marina, Facciorusso, Antonio, Cacciato, Valentina, Casagrande, Edoardo, Moscatelli, Alessandro, Pellegatta, Gaia, de Matthaeis, Nicoletta, Allegrini, Gloria, Lauria, Valentina, Ghittoni, Giorgia, Pelecca, Giorgio, Chegai, Fabrizio, Coratella, Fabio, Ortenzi, Mariano, Missale, Gabriele, Inno, Alessandro, Marchetti, Fabiana, Busacca, Anita, Cammà, Calogero, Martino, Vincenzo Di, Emanuele Maria Rizzo, Giacomo, Franzè, Maria Stella, Saitta, Carlo, Sauchella, Assunta, Bevilacqua, Vittoria, Borghi, Alberto, Casadei Gardini, Andrea, Conti, Fabio, Dall'Aglio, Anna Chiara, Ercolani, Giorgio, Mirici, Federica, Campani, Claudia, Bonaventura, Chiara Di, Gitto, Stefano, Coccoli, Pietro, Malerba, Antonio, Guarino, Maria, Brunetto, Maurizia, Romagnoli, Veronica, Giannini, Edoardo G, Svegliati-Baroni, Gianluca, for the Italica, Group, Pelizzaro F., Penzo B., Peserico G., Imondi A., Sartori A., Vitale A., Cillo U., Giannini E.G., Forgione A., Ludovico Rapaccini G., Di Marco M., Caturelli E., Zoli M., Sacco R., Cabibbo G., Marra F., Mega A., Morisco F., Gasbarrini A., Svegliati-Baroni G., Giuseppe Foschi F., Olivani A., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Oliveri F., Trevisani F., Farinati F., Biselli M., Caraceni P., Garuti F., Gramenzi A., Neri A., Santi V., Granito A., Muratori L., Piscaglia F., Sansone V., Tovoli F., Dajti E., Marasco G., Ravaioli F., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Sammarco A., Cela E.M., Facciorusso A., Cacciato V., Casagrande E., Moscatelli A., Pellegatta G., de Matthaeis N., Allegrini G., Lauria V., Ghittoni G., Pelecca G., Chegai F., Coratella F., Ortenzi M., Missale G., Inno A., Marchetti F., Busacca A., Qabibboz G., Camma C., Martino V.D., Emanuele Maria Rizzo G., Franze M.S., Saitta C., Sauchella A., Bevilacqua V., Borghi A., Casadei Gardini A., Conti F., Dall'Aglio A.C., Ercolani G., Mirici F., Campani C., Bonaventura C.D., Gitto S., Coccoli P., Malerba A., Guarino M., Brunetto M., Romagnoli V., Rapaccini, Gian Ludovico, and Foschi, Francesco Giuseppe

Subjects
medicine.medical_specialty, Multivariate analysis, Carcinoma, Hepatocellular, Independent predictor, Gastroenterology, Resection, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Overall survival, Hepatectomy, Humans, Staging system, Neoplasm Staging, Retrospective Studies, Settore MED/12 - Gastroenterologia, Hepatology, treatment, business.industry, Settore MED/09 - MEDICINA INTERNA, Liver Neoplasms, bclc staging system, monofocal hepatocellular carcinoma, medicine.disease, digestive system diseases, Survival benefit, Italy, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, liver resection, prognosis, 030211 gastroenterology & hepatology, business, Liver cancer, prognosi
Abstract

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 (>5cm) monofocal (HCC). Methods: From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5cm; SEM-HCC), 163 patients with larger tumours (>5cm; 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 49.0months; P&nbsp

Published
2021

14. Hepatocellular carcinoma in non-cirrhotic liver: A reappraisal

Author

Franco Trevisani, V. Santi, Mauro Bernardi, Alice Grignaschi, Marta Frigerio, Trevisani F, Frigerio M, Santi V, Grignaschi A, and Bernardi M.

Subjects
Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, LIVER CIRRHOSIS, Hepatitis, Viral, Human, medicine.medical_treatment, LIVER FIBROSIS, Liver transplantation, Gastroenterology, Disease-Free Survival, Young Adult, Age Distribution, Internal medicine, medicine, Carcinoma, Hepatectomy, Humans, HEPATOCELLULAR CARCINOMA, Aged, Aged, 80 and over, Hepatitis, Hepatology, business.industry, Liver Neoplasms, Fatty liver, FATTY LIVER, CHRONIC HEPATITIS, Middle Aged, Hepatitis B, medicine.disease, Alcoholism, Hepatocellular carcinoma, Female, Liver function, business, Prejudice
Abstract

Although not frequently, hepatocellular carcinoma (HCC) can ensue in a non-cirrhotic liver. As compared to cirrhotic HCC, this kind of tumour has some peculiarities, such as: (a) a lower male preponderance and a bimodal age distribution; (b) a lower prevalence of the three main risk factors (hepatitis B and C virus infections and alcohol abuse), with an increased prevalence of other etiologic factors, such as exposure to genotoxic substances and sex hormones, inherited diseases, genetic mutations; (c) a more advanced tumour stage at the time of diagnosis, as it is usually detected due to the occurrence of cancer-related symptoms, outside any scheduled surveillance program; (d) a much higher amenability to hepatic resection, due to the low risk of liver failure even after extended parenchymal mutilation; (e) overall and disease-free survivals after resection of non-advanced tumours (meeting the Milano criteria) comparable to that obtained with liver transplantation in cirrhotic patients carrying an early tumour; (f) overall survival strictly dependent on tumour burden (and its recurrence) and barely influenced by liver function.

Published
2010

15. Surveillance for early diagnosis of hepatocellular carcinoma: is it effective in intermediate/advanced cirrhosis?

Author

V. Santi, TREVISANI, FRANCO, GRAMENZI, ANNAGIULIA, R. Casadio, A. M. Di Nolfo, P. Del Poggio, L. Benvegnù, G. Rapaccini, F. Farinati, ZOLI, MARCO, F. Borzio, E. G. Giannini, E. Caturelli, BERNARDI, MAURO, V. Santi, F. Trevisani, A. Gramenzi, R. Casadio, A.M. Di Nolfo, P. Del Poggio, L. Benvegnù, G. Rapaccini, F. Farinati, M. Zoli, F. Borzio, E.G. Giannini, E. Caturelli, M. Bernardi., Trevisani F, Santi V, Gramenzi A, Di Nolfo MA, Poggio PD, Benvegnù L, Rapaccini G, Farinati F, Zoli M, Borzio F, Giovanni Giannini E, Caturelli E, Bernardi M, and for the Italian Liver Cancer (ITA.LI.CA.) group.

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, PROGNOSIS, Gastroenterology, Liver Function Tests, Internal medicine, SURVEILLANCE, Biomarkers, Tumor, Carcinoma, medicine, Humans, Prospective Studies, HEPATOCELLULAR CARCINOMA, Survival rate, CIRRHOSIS, Aged, Neoplasm Staging, Proportional Hazards Models, Ultrasonography, Hepatology, medicine.diagnostic_test, business.industry, Advanced cirrhosis, Liver Neoplasms, Cancer, Anatomical pathology, Middle Aged, medicine.disease, digestive system diseases, Survival Rate, EARLY DIAGNOSIS, Italy, Population Surveillance, Hepatocellular carcinoma, Female, alpha-Fetoproteins, Liver function tests, business
Abstract

Surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein (AFP) measurement, is widely used. Its effectiveness depends on liver function, which affects the feasibility of treatments and cirrhosis-related mortality. We assessed whether patients with intermediate/advanced cirrhosis benefit from surveillance.We selected 468 Child-Pugh class B and 140 class C patients from the ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to December 2004. HCC was detected in 252 patients during surveillance (semiannual 172, annual 80 patients; group 1) and in 356 patients outside surveillance (group 2). Survival of surveyed patients was corrected for the estimated lead time.Child-Pugh class B: cancer stage (P0.001) and treatment distribution (P0.001) were better in group 1 than in group 2. The median (95% CI) survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival rates at 1, 3, and 5 yr were 60.4%versus 49.2%, 26.1%versus 16.1%, and 10.7%versus 4.3%, respectively (P= 0.022). AFP, gross pathology, and treatment of HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P= 0.001) and treatment distribution (P= 0.021) were better in group 1 than in group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0 (4.1-7.9) months (P= 0.740).These results suggest surveillance be offered to class B patients and maintained for class A patients who migrate to the subsequent class. Surveillance becomes pointless in class C patients probably because the poor liver function adversely affects the overall mortality and HCC treatments.

Published
2007

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