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Early and very early hepatocellular carcinoma: when and how much do staging and choice of treatment really matter? A multi-center study
- Source :
- BMC Cancer, Vol 9, Iss 1, p 33 (2009), BMC Cancer
- Publication Year :
- 2009
- Publisher :
- BMC, 2009.
-
Abstract
- Background A consensus on the most reliable staging system for hepatocellular carcinoma (HCC) is still lacking but the most used is a revised Barcelona Clinic Liver Cancer (BCLC) system, adopted by the American Association for the Study of Liver Diseases (AASLD). We investigated how many patients are diagnosed in "very early" and "early" stage, follow the AASLD guidelines for treatment and whether their survival depends on treatment. Methods Data were collected in 530 "very early" and "early" HCC patients recruited by a multicentric Italian collaborative group (ITA.LI.CA). The Kaplan-Meier method was used to estimate overall survival and the log rank to test the statistical significance of difference between groups. Cox's multivariate stepwise regression analysis was used to pinpoint independent prognostic factors and the adjusted relative risks (hazard ratios) were calculated as well. A statistical analysis based on the chi-square test was used to identify significant differences in clinical or pathological features between patients. A P-value < 0.05 was considered statistically significant. Results "Very early" HCC were 3%; Cox multivariate analysis did not identify variables independently associated with survival. The patients following AASLD recommendations (20%) did not show longer survival. In "early" HCC patients (25%), treatment significantly modulated survival (p = 0.0001); the 28% patients treated according to the AASLD criteria survived longer (p = 0,004). The Cox analysis however identified only age, gender, number of lesions and Child class as independent predictors of survival. Conclusion patients with very early" HCC were very few in this analysis. In most instances they were not treated with the treatment suggested as the most appropriate by the AASLD guidelines and the type of treatment had no impact on survival, even though the number of patients was relatively low and part of the patients were diagnosed before the introduction of the guidelines: this analysis, therefore, might not be considered as conclusive and should be validated. The "early" stage group involved more patients, rarely treated according to the guidelines, both overall and also in those diagnosed after their publication; the survival was in part predicted by the type of treatment, with better results in those treated according to AASLD indications.
- Subjects :
- Male
Cancer Research
Multivariate analysis
Survival
medicine.medical_treatment
PROGNOSTIC SYSTEM
Medicine
PATIENT SURVIVAL
PERCUTANEOUS ETHANOL INJECTION, RADIOFREQUENCY ABLATION, PROGNOSTIC SYSTEM, PATIENT SURVIVAL, CLIP, BCLC, CIRRHOSIS, JAPAN, JIS, CLASSIFICATION
Stage (cooking)
CIRRHOSIS
Early Detection of Cancer
Aged, 80 and over
Hazard ratio
Age Factors
CLIP
TREATMENT
Middle Aged
Prognosis
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Treatment Outcome
Oncology
Italy
Hepatocellular carcinoma
Practice Guidelines as Topic
Female
Guideline Adherence
Research Article
medicine.medical_specialty
Carcinoma, Hepatocellular
lcsh:RC254-282
CLASSIFICATION
Sex Factors
VERY EARLY STAGE
Internal medicine
Genetics
Early Hepatocellular Carcinoma
Humans
HEPATOCELLULAR CARCINOMA
RADIOFREQUENCY ABLATION
Aged
Neoplasm Staging
Retrospective Studies
JAPAN
business.industry
medicine.disease
Surgery
JIS
Log-rank test
BCLC
Relative risk
Multivariate Analysis
PERCUTANEOUS ETHANOL INJECTION
Percutaneous ethanol injection
EARLY STAGE
business
Subjects
Details
- Language :
- English
- ISSN :
- 14712407
- Volume :
- 9
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Cancer
- Accession number :
- edsair.doi.dedup.....bec29ff264238dab72f41d30ff66bf5c