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Trend of improving prognosis of hepatocellular carcinoma in clinical practice: an Italian in-field experience.
Trend of improving prognosis of hepatocellular carcinoma in clinical practice: an Italian in-field experience.
- Source :
-
Digestive diseases and sciences [Dig Dis Sci] 2015 May; Vol. 60 (5), pp. 1465-73. Date of Electronic Publication: 2014 Nov 16. - Publication Year :
- 2015
-
Abstract
- Background: Recent data suggest that outcome of hepatocarcinoma is improving.<br />Aims: In order to explore whether survival is also increasing in clinical practice, we compared two multicenter independent in-field cohorts of cirrhotics with newly diagnosed HCCs.<br />Methods: Cohort 1 (C1) consisted of 327 patients enrolled between January and December 1998, and cohort 2 (C2) included 826 patients enrolled between September 2008 and November 2012. Patients were stratified according to Child-Pugh score, MELD score, and HCC staged according to TNM, BCLC systems.<br />Results: At baseline, C2 patients were significantly older, with more frequent comorbidities and better liver function. In C2, HCC was more frequently detected under regular ultrasound surveillance (P < 0.001), BCLC early stages were more frequent, and rates of smaller and uni/paucinodular tumors were significantly higher. Treatment of any type was more frequently offered to C2 patients (P < 0.001). Proportion of patients treated by TACE increased, and radiofrequency ablation was the most used ablative treatment. Survival rate was significantly higher in C2 being C1 and C2 survival at 1-3 years 72-25 and 75-44 %, respectively. Child-Pugh score A, BCLC stage A, single nodule, size ≤ 3 cm, belonging to cohort C2 and treatment per se independently predicted survival.<br />Conclusions: This in-field study showed a trend on improved HCC outcomes over time, which seems to be mainly due to a better presentation thanks to the wider application of surveillance and increased propensity to treat patients. These encouraging data should support further efforts to implement such approach to HCC in everyday clinical practice.
- Subjects :
- Aged
Carcinoma, Hepatocellular etiology
Carcinoma, Hepatocellular mortality
Female
Humans
Italy
Kaplan-Meier Estimate
Liver Cirrhosis diagnosis
Liver Cirrhosis mortality
Liver Neoplasms etiology
Liver Neoplasms mortality
Male
Middle Aged
Neoplasm Staging
Practice Patterns, Physicians' trends
Predictive Value of Tests
Quality Improvement trends
Quality Indicators, Health Care trends
Risk Factors
Time Factors
Treatment Outcome
Carcinoma, Hepatocellular diagnosis
Carcinoma, Hepatocellular therapy
Early Detection of Cancer trends
Liver Cirrhosis complications
Liver Neoplasms diagnosis
Liver Neoplasms therapy
Outcome Assessment, Health Care trends
Subjects
Details
- Language :
- English
- ISSN :
- 1573-2568
- Volume :
- 60
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Digestive diseases and sciences
- Publication Type :
- Academic Journal
- Accession number :
- 25399329
- Full Text :
- https://doi.org/10.1007/s10620-014-3427-5