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Pelizzaro F, Trevisani F, Simeon V, Vitale A, Cillo U, Piscaglia F, Missale G, Sangiovanni A, Foschi FG, Cabibbo G, Caturelli E, Di Marco M, Azzaroli F, Brunetto MR, Raimondo G, Vidili G, Guarino M, Gasbarrini A, Campani C, Svegliati-Baroni G, Giannini EG, Mega A, Masotto A, Rapaccini GL, Magalotti D, Sacco R, Nardone G, Farinati F. Predictors of non-transplantable recurrence in hepatocellular carcinoma patients treated with frontline liver resection. Liver Int 2023; 43:2762-2775. [PMID: 37753540 DOI: 10.1111/liv.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) recurrence is common in patients treated with liver resection (LR). In this study, we aimed to evaluate the incidence and preoperative predictors of non-transplantable recurrence in patients with single HCC ≤5 cm treated with frontline LR. METHODS From the Italian Liver Cancer (ITA.LI.CA) database, 512 patients receiving frontline LR for single HCC ≤5 cm were retrieved. Incidence and predictors of recurrence beyond Milan criteria (MC) and up-to-seven criteria were compared between patients with HCC <4 and ≥4 cm. RESULTS During a median follow-up of 4.2 years, the overall recurrence rate was 55.9%. In the ≥4 cm group, a significantly higher proportion of patients recurred beyond MC at first recurrence (28.9% vs. 14.1%; p < 0.001) and overall (44.4% vs. 25.2%; p < 0.001). Similar results were found considering recurrence beyond up-to-seven criteria. Compared to those with larger tumours, patients with HCC <4 cm had a longer recurrence-free survival and overall survival. HCC size ≥4 cm and high alpha-fetoprotein (AFP) level at the time of LR were independent predictors of recurrence beyond MC (and up-to-seven criteria). In the subgroup of patients with available histologic information (n = 354), microvascular invasion and microsatellite lesions were identified as additional independent risk factors for non-transplantable recurrence. CONCLUSIONS Despite the high recurrence rate, LR for single HCC ≤5 cm offers excellent long-term survival. Non-transplantable recurrence is predicted by HCC size and AFP levels, among pre-operatively available variables. High-risk patients could be considered for frontline LT or listed for transplantation even before recurrence.
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Affiliation(s)
- Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Franco Trevisani
- Unit of Semeiotics, Liver and Alcohol-related diseases, Department of Medical and Surgical Sciences, Università di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, Mental, Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Hepatobiliary Surgery and Liver Transplantation Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Hepatobiliary Surgery and Liver Transplantation Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriele Missale
- Department of Medicine and Surgery, Unit of Infectious Diseases and Hepatology, University of Parma, Parma, Italy
| | - Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco G Foschi
- Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | | | | | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine Unit, University of Pisa, Pisa, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Gianpaolo Vidili
- Department of Medicine Surgery and Pharmacy, Centralized Day Hospital of the medical area, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University of Napoli 'Federico II', Napoli, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | | | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gian Ludovico Rapaccini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Donatella Magalotti
- Division of Internal Medicine, Neurovascular and Hepatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli 'Federico II', Napoli, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
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2
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Giannini EG, Pieri G, Labanca S, Plaz Torres MC, Gasbarrini A, Biasini E, Campani C, Cazzagon N, Foschi FG, Mega A, Masotto A, Raimondo G, Rapaccini GL, Sacco R, Caturelli E, Guarino M, Tovoli F, Vidili G, Brunetto MR, Nardone G, Svegliati-Baroni G, Magalotti D, Azzaroli F, Cabibbo G, Di Marco M, Sangiovanni A, Trevisani F. Characteristics and survival of patients with primary biliary cholangitis and hepatocellular carcinoma. Dig Liver Dis 2022; 54:1215-1221. [PMID: 35354543 DOI: 10.1016/j.dld.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/15/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Comprehensive and contemporary data pertaining large populations of patients with Primary Biliary Cholangitis (PBC) and hepatocellular carcinoma (HCC) are missing. AIM To describe main characteristics and outcome of PBC patients with HCC diagnosed in the new millennium. METHODS Analysing the Italian Liver Cancer registry we identified 80 PBC patients with HCC diagnosed after the year 2000, and described their clinical characteristics, access to treatment and survival. RESULTS Median age of patients was 71 years and 50.0% were males. Cirrhosis was present in 86.3% of patients, being well-compensated in 58.0%. Median HCC diameter was smaller in patients under surveillance (2.6 vs 4.0 cm, P = 0.007). Curative treatment, feasible in 50.0% of patients, was associated with improved survival compared to palliative and supportive care (42 vs 33 vs 6 months, P<0.0001). Surveillance was associated with a non-significant improved survival (36 vs 23 months), likely due to similar rate of curative treatment in patients under (51.4%) and outside surveillance (42.6%). CONCLUSIONS PBC patients with HCC are often elderly males with well-preserved liver function. Feasibility of curative treatment is high and associated with improved prognosis. Description of these patients may help focus surveillance to identify earlier tumours, increase their curability, and improve prognosis.
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Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Sara Labanca
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elisabetta Biasini
- Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | - Nora Cazzagon
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | | | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | | | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | | | - Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli ``Federico II'', Napoli, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine Unit, University of Pisa, Pisa, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli ``Federico II'', Napoli, Italy
| | | | - Donatella Magalotti
- Division of Internal Medicine, Neurovascular and Epatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | | | - Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and C.R.C. "A.M. & A. Migliavacca Center for Liver Disease", Milan, Italy
| | - Franco Trevisani
- Division of Medical Semeiotics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Pelizzaro F, Peserico G, D'Elia M, Cazzagon N, Russo FP, Vitale A, Giannini EG, Piccinnu M, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Cabibbo G, Marra F, Mega A, Morisco F, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Oliveri F, Trevisani F, Farinati F. Surveillance for hepatocellular carcinoma with a 3-months interval in "extremely high-risk" patients does not further improve survival. Dig Liver Dis 2022; 54:927-936. [PMID: 34580038 DOI: 10.1016/j.dld.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Giulia Peserico
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy; Veneto Institute of Oncology, Gastroenterology Unit, Via dei Carpani 16/Z, 31033, Castelfranco Veneto, Italy
| | - Marco D'Elia
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Nora Cazzagon
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Multivisceral Transplant Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Policlinico San Martino, Viale Benedetto XV 6, 16132, Genova, Italy
| | - Manuela Piccinnu
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 13, 40138, Bologna, Italy
| | - Gian Ludovico Rapaccini
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Via della Pineta Sacchetti 217, 00168, Roma, Italy
| | - Maria Di Marco
- Medicine Unit, Bolognini Hospital, Via Paderno 21, 24068, Seriate, Italy
| | - Eugenio Caturelli
- Gastroenterology Unit, Belcolle Hospital, Str. Sammartinese, 01100, Viterbo, Italy
| | - Marco Zoli
- Internal Medicine-Zoli Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 13, 40138, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Viale Luigi Pinto 1, 71122, Foggia, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Largo Brambilla 3, 50134, Firenze, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Via Lorenz Böhler 5, 39100, Bolzano, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Via Pansini 5, 80131, Napoli, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Via della Pineta Sacchetti 217, 00168, Roma, Italy
| | | | - Francesco Giuseppe Foschi
- Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Viale Stradone 9, 48018, Faenza, Italy
| | - Andrea Olivani
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Viale Antonio Gramsci 14, 43126, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Viale Luigi Rizzardi 4, 37024, Negrar, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Via Pansini 5, 80131, Napoli, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Piazza Pugliatti 1, 98122, Messina, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 13, 40138, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Viale S. Pietro 43/B, 07100, Sassari, Italy
| | - Filippo Oliveri
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine Unit, University of Pisa, Lungarno Antonio Pacinotti 43, 56126, Pisa, Italy
| | - Franco Trevisani
- Medical Semeiotics Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 13, 40138, Bologna, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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Pelizzaro F, Haxhi S, Penzo B, Vitale A, Giannini EG, Sansone V, Rapaccini GL, Di Marco M, Caturelli E, Magalotti D, Sacco R, Celsa C, Campani C, Mega A, Guarino M, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Trevisani F, Farinati F. Transarterial Chemoembolization for Hepatocellular Carcinoma in Clinical Practice: Temporal Trends and Survival Outcomes of an Iterative Treatment. Front Oncol 2022; 12:822507. [PMID: 35174092 PMCID: PMC8841805 DOI: 10.3389/fonc.2022.822507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background Transarterial chemoembolization (TACE) is one of the most frequently applied treatments for hepatocellular carcinoma (HCC) worldwide. In this study, we aimed at evaluating whether and how TACE application and repetition, as well as the related outcome, have changed over the last three decades in Italy. Methods Data of 7,184 patients with HCC were retrieved from the Italian Liver Cancer (ITA.LI.CA) database. Patients were divided according to the period of diagnosis in six cohorts: P1 (1988–1993), P2 (1994–1998), P3 (1999–2004), P4 (2005–2009), P5 (2010–2014), and P6 (2015–2019). All the analyses were repeated in the overall patient population and in Barcelona Clinic Liver Cancer (BCLC) B patients, who are the subgroup of HCC patients originally supposed to receive TACE according to guidelines. TACE was defined as either the first or the main (more effective) treatment. Results The proportion of patients receiving TACE as first or main therapy declined over time, and less than 50% of BCLC B patients were treated with chemoembolization from P3 onward. Conversely, TACE was widely used even outside the intermediate stage. Survival of TACE-treated patients progressively increased from P1 to P6. Although TACE was performed only once in the majority of patients, there was an increasing proportion of those receiving 2 or ≥3 treatments sessions over time. The overall survival (OS) of patients undergoing repeated treatments was significantly higher compared to those managed with a single TACE (median OS 40.0 vs. 65.0 vs. 71.8 months in 1, 2, and ≥3 TACE groups, respectively; p < 0.0001). However, after a first-line TACE, the adoption of curative therapies provided longer survival than repeating TACE (83.0 vs. 42.0 months; p < 0.0001), which in turn was associated with better outcomes compared to systemic therapies or best supportive care (BSC). Conclusions Despite a decline in the percentage of treated patients over time, TACE has still an important role in the management of HCC patients. The survival of TACE-treated patients gradually improved over time, probably due to a better patient selection. Iterative TACE is effective, but an upward shift to curative therapies provides better outcomes while transition to systemic therapies and BSC leads to a worse prognosis.
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Affiliation(s)
- Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Selion Haxhi
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Barbara Penzo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Vito Sansone
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gian Ludovico Rapaccini
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | | | | | - Donatella Magalotti
- Internal Medicine Unit, Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Ciro Celsa
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties (PROMISE), Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli “Federico II”, Napoli, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Andrea Olivani
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli “Federico II”, Napoli, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine Unit, University of Pisa, Pisa, Italy
| | - Franco Trevisani
- Medical Semeiotics Unit, Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
- *Correspondence: Fabio Farinati,
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5
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Cucchetti A, Gramenzi A, Johnson P, Giannini EG, Tovoli F, Rapaccini GL, Marra F, Cabibbo G, Caturelli E, Gasbarrini A, Svegliati-Baroni G, Sacco R, Zoli M, Morisco F, Di Marco M, Mega A, Foschi FG, Biasini E, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Farinati F, Trevisani F. Material deprivation affects the management and clinical outcome of hepatocellular carcinoma in a high-resource environment. Eur J Cancer 2021; 158:133-143. [PMID: 34666215 DOI: 10.1016/j.ejca.2021.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
AIM This study investigated how material deprivation in Italy influences the stage of hepatocellular carcinoma (HCC) at diagnosis and the chance of cure. METHODS 4114 patients from the Italian Liver Cancer database consecutively diagnosed with HCC between January 2008 and December 2018 were analysed about severe material deprivation (SMD) rate tertiles of the region of birth and region of managing hospitals, according to the European Statistics on Income and Living Conditions. The main outcomes were HCC diagnosis modalities (during or outside surveillance), treatment adoption and overall survival. RESULTS In more deprived regions, HCC was more frequently diagnosed during surveillance, while the incidental diagnosis was prevalent in the least deprived. Tumour characteristics did not differ among regions. The proportion of patients undergoing potentially curative treatments progressively decreased as the SMD worsened. Consequently, overall survival was better in less deprived regions. Patients who moved from most deprived to less deprived regions increased their probability of receiving potentially curative treatments by 1.11 times (95% CI 1.03 to 1.19), decreasing their mortality likelihood (hazard ratio 0.78 95% CI 0.67 to 0.90). CONCLUSIONS Socioeconomic status measured through SMD does not seem to influence HCC features at diagnosis but brings a negative effect on the chance of receiving potentially curative treatments. Patient mobility from the most deprived to the less deprived regions increased the access to curative therapies, with the ultimate result of improving survival.
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Affiliation(s)
- Alessandro Cucchetti
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Morgagni-Pierantoni Hospital, Forlì, Italy.
| | - Annagiulia Gramenzi
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, University of Bologna, Italy.
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK.
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, IRCCS Policlinico San Martino, University of Genova, Italy.
| | - Francesco Tovoli
- Internal Medicine Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Gian Ludovico Rapaccini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Roma, Italy.
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Firenze, Italy.
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties (PROMISE), Section of Gastroenterology and Hepatology, University of Palermo, Italy.
| | | | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Roma, Italy.
| | | | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy, Foggia University Hospital, Foggia, Italy.
| | - Marco Zoli
- Department of Medical and Surgical Sciences, Internal Medicine Unit, University of Bologna, Italy.
| | - Filomena Morisco
- Department of Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Italy.
| | | | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy.
| | - Francesco G Foschi
- Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Italy.
| | - Elisabetta Biasini
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Italy.
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Italy.
| | - Francesco Azzaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Italy.
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Italy.
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, Italy.
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, University of Bologna, Italy.
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Guarino M, Cucchetti A, Pontillo G, Farinati F, Benevento F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Rodolfo S, Cabibbo G, Marra F, Mega A, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Missale G, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Oliveri F, Trevisani F, Giannini EG, Morisco F. Pattern of macrovascular invasion in hepatocellular carcinoma. Eur J Clin Invest 2021; 51:e13542. [PMID: 33755196 DOI: 10.1111/eci.13542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/27/2021] [Accepted: 03/10/2021] [Indexed: 02/05/2023]
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 6.0 months (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 2.4 months in those with PS > 1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1 months 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.
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Affiliation(s)
- Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, General Surgery of the Morgagni-Pierantoni Hospital Forlì, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy
| | - Giuseppina Pontillo
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Francesca Benevento
- Division of Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | - Marco Zoli
- Department of Medical and Surgical Sciences, Internal Medicine Unit, University of Bologna, Bologna, Italy
| | - Sacco Rodolfo
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Gabriele Missale
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Francesco Azzaroli
- Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum-Università of Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Filippo Oliveri
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, Pisa, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
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Campani C, Vitale A, Dragoni G, Arena U, Laffi G, Cillo U, Giannini EG, Tovoli F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Cabibbo G, Mega A, Guarino M, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Biasini E, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Farinati F, Trevisani F, Marra F. Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Liver Cancer 2021; 10:126-136. [PMID: 33977089 PMCID: PMC8077424 DOI: 10.1159/000513404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/31/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). METHODS An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. RESULTS The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10-1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. CONCLUSION An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.
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Affiliation(s)
- Claudia Campani
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Gabriele Dragoni
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Umberto Arena
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giacomo Laffi
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Francesco Tovoli
- Internal Medicine-Piscaglia Unit, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | | | | | - Marco Zoli
- Internal Medicine-Zoli Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Giuseppe Cabibbo
- Gastroenterology & Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Svegliati-Baroni
- Liver Injury and Transplant Unit, and Obesity Center, Polytechnic University of Marche, Ancona, Italy
| | | | - Elisabetta Biasini
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Hepato-Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Giovanni Raimondo
- Clinical and Molecular Hepatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, Alma Mater Studiorum − Università of Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Sassari, Italy
- Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Maurizia Rossana Brunetto
- Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Fabio Marra
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- *Fabio Marra, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Largo Brambilla, 3, IT–50134 Florence (Italy),
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8
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Garuti F, Neri A, Avanzato F, Gramenzi A, Rampoldi D, Rucci P, Farinati F, Giannini EG, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Cabibbo G, Marra F, Mega A, Morisco F, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Missale G, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Trevisani F. The changing scenario of hepatocellular carcinoma in Italy: an update. Liver Int 2021; 41:585-597. [PMID: 33219585 DOI: 10.1111/liv.14735] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/26/2020] [Accepted: 11/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15 years. METHODS Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004-2008, 2009-2013 and 2014-2018). RESULTS The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non-viral cases and, particularly, of 'metabolic' and 'metabolic + alcohol' HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients. CONCLUSIONS During the last 15 years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients.
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Affiliation(s)
- Francesca Garuti
- Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Neri
- Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Avanzato
- Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annagiulia Gramenzi
- Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Rampoldi
- Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Policlinico San Martino, Genova, Italy
| | - Fabio Piscaglia
- Internal Medicine-Piscaglia Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | - Marco Zoli
- Internal Medicine-Zoli Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Francesco G Foschi
- Department of Internal Medicine, Ospedale per gli Infermi of Faenza, Faenza, Italy
| | - Gabriele Missale
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria of Sassari, Sassari, Italy
| | - Maurizia R Brunetto
- Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Franco Trevisani
- Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Carr BI, Guerra V, Donghia R, Farinati F, Giannini EG, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Cabibbo G, Marra F, Mega A, Morisco F, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Missale G, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Oliveri F, Trevisani F. Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter. Int J Biol Markers 2021; 36:54-61. [PMID: 33641486 DOI: 10.1177/1724600821996372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. AIMS To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. METHODS A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. RESULTS A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels (P<0.001) and an increased percentage of patients with either portal vein thrombosis or tumor multifocality, each P<0.0001. Furthermore, the increases of both alpha-fetoprotein and portal vein thrombosis were proportionately greater than the related maximum tumor diameter increases. These trends of increased alpha-fetoprotein, portal vein thrombosis, and multifocality with increasing maximum tumor diameter had non-linear patterns. Within alpha-fetoprotein and multifocality trends, there were identifiable sub-trends associated with specific maximum tumor diameter ranges. CONCLUSIONS The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.
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Affiliation(s)
- Brian I Carr
- Inonu University, Liver Transplant Institute, Malatya, Turkey
| | - Vito Guerra
- National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy
| | - Rossella Donghia
- National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Policlinico San Martino, Genova, Italy
| | - Fabio Piscaglia
- Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Internal Medicine-Piscaglia Unit, Bologna, Italy
| | | | | | | | - Marco Zoli
- Department of Medical and Surgical Sciences, Internal Medicine-Zoli Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Gabriele Missale
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Francesco Azzaroli
- Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences. Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria of Sassari, Sassari, Italy
| | - Filippo Oliveri
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, Pisa, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Pelizzaro F, Vitale A, Sartori A, Vieno A, Penzo B, Russo FP, Frigo AC, Giannini EG, Piccinnu M, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Celsa C, Marra F, Mega A, Guarino M, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Coccoli P, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Trevisani F, Farinati F. Surveillance as Determinant of Long-Term Survival in Non-Transplanted Hepatocellular Carcinoma Patients. Cancers (Basel) 2021; 13:897. [PMID: 33672751 PMCID: PMC7924561 DOI: 10.3390/cancers13040897] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We aimed at assessing the impact of surveillance on long-term survival in HCC patients. METHODS From the ITA.LI.CA database, we selected 1028 cases with long (≥5 years, LS group) and 2721 controls with short-term survival (<5 years, SS group). The association between surveillance and LS was adjusted for confounders by multivariable logistic regression analysis. Survival of surveilled patients was presented both as observed and corrected for the lead-time bias, and the comparison of survival between surveillance and no surveillance groups was also performed after balancing the baseline characteristics with inverse probability weights (IPW). RESULTS LS patients were more frequently diagnosed under surveillance (p < 0.0001), and had more favorable baseline characteristics. Surveillance was an independent predictor of LS (OR = 1.413, 95% CI 1.195-1.671; p < 0.0001). The observed and the lead-time corrected survival of surveilled patients were significantly longer compared to the survival of not surveilled patients (p < 0.0001 and p = 0.0008, respectively). In IPW adjusted populations, no survival differences were demonstrated between the two groups (p = 0.30). CONCLUSIONS Surveillance, increasing early-stage diagnosis and applicability of curative treatments, is a fundamental determinant of long-term survival in HCC patients. A wide implementation of surveillance programs should be pursued in order to improve HCC patients' prognosis.
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Affiliation(s)
- Filippo Pelizzaro
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (F.P.); (A.S.); (A.V.); (B.P.); (F.P.R.)
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy;
| | - Anna Sartori
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (F.P.); (A.S.); (A.V.); (B.P.); (F.P.R.)
| | - Andrea Vieno
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (F.P.); (A.S.); (A.V.); (B.P.); (F.P.R.)
| | - Barbara Penzo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (F.P.); (A.S.); (A.V.); (B.P.); (F.P.R.)
| | - Francesco Paolo Russo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (F.P.); (A.S.); (A.V.); (B.P.); (F.P.R.)
| | - Anna Chiara Frigo
- Biostatistics Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genova, IRCCS Policlinico San Martino, 16132 Genova, Italy;
| | - Manuela Piccinnu
- Internal Medicine–Piscaglia Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy;
| | - Gian Ludovico Rapaccini
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Maria Di Marco
- Medicine Unit, Bolognini Hospital, 24068 Seriate, Italy;
| | | | - Marco Zoli
- Internal Medicine–Zoli Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy;
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71122 Foggia, Italy;
| | - Ciro Celsa
- Gastroenterology & Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, University of Palermo, 90133 Palermo, Italy;
| | - Fabio Marra
- Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Firenze, 50121 Firenze, Italy;
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, 39100 Bolzano, Italy;
| | - Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Napoli “Federico II”, 80138 Napoli, Italy;
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | | | | | - Andrea Olivani
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Pietro Coccoli
- Hepato-Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Napoli “Federico II”, 80138 Napoli, Italy;
| | - Giovanni Raimondo
- Clinical and Molecular Hepatology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Francesco Azzaroli
- Gastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy;
| | - Gianpaolo Vidili
- Clinica Medica Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Franco Trevisani
- Medical Semeiotics Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Fabio Farinati
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (F.P.); (A.S.); (A.V.); (B.P.); (F.P.R.)
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11
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Carr BI, Guerra V, Donghia R, Farinati F, Giannini EG, Muratori L, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Celsa C, Campani C, Mega A, Guarino M, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Biasini E, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Brunetto MR, Trevisani F. Identification of Clinical Phenotypes and Related Survival in Patients with Large HCCs. Cancers (Basel) 2021; 13:cancers13040592. [PMID: 33546234 PMCID: PMC7913341 DOI: 10.3390/cancers13040592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. AIM To examine patterns of tumor factors in large HCC patients. METHODS A database of large HCC patients was examined. RESULTS A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. CONCLUSIONS Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.
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Affiliation(s)
- Brian I. Carr
- Translational HCC Research Department, Liver Transplant Institute, Inonu University, Malatya 44000, Turkey
- Correspondence: ; Tel.: +14-12-980-4518
| | - Vito Guerra
- Clinical Trials Department, National Institute of Digestive Diseases, IRCCS S. de Bellis Research Hospital, 70013 Castellana Grotte, Italy; (V.G.); (R.D.)
| | - Rossella Donghia
- Clinical Trials Department, National Institute of Digestive Diseases, IRCCS S. de Bellis Research Hospital, 70013 Castellana Grotte, Italy; (V.G.); (R.D.)
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy;
| | - Edoardo G. Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Luca Muratori
- Internal Medicine–Piscaglia Unit, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, 40138 Bologna, Italy;
| | - Gian Ludovico Rapaccini
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Maria Di Marco
- Medicine Unit, Bolognini Hospital, 24068 Seriate, Italy;
| | | | - Marco Zoli
- Department of Medical and Surgical Sciences, Internal Medicine–Zoli Unit, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy;
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71122 Foggia, Italy;
| | - Ciro Celsa
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, 90133 Palermo, Italy;
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, 50121 Firenze, Italy;
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, 39100 Bolzano, Italy;
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli “Federico II”, 80138 Napoli, Italy;
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | | | | | - Elisabetta Biasini
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy;
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli “Federico II”, 37024 Napoli, Italy;
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Division of Medicine and Hepatology, University of Messina, 98122 Messina, Italy;
| | - Francesco Azzaroli
- Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy;
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria of Sassari, 07100 Sassari, Italy;
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Franco Trevisani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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12
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Pelizzaro F, Penzo B, Peserico G, Imondi A, Sartori A, Vitale A, Cillo U, Giannini EG, 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. Monofocal hepatocellular carcinoma: How much does size matter? Liver Int 2021; 41:396-407. [PMID: 33155401 DOI: 10.1111/liv.14718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/07/2020] [Accepted: 10/31/2020] [Indexed: 02/05/2023]
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 (>5 cm) monofocal (HCC). METHODS From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5 cm; SEM-HCC), 163 patients with larger tumours (>5 cm; 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 49.0 months; P < .0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29-2.05; P < .0001). The small difference in OS between LEM-HCC and BCLC B patients (31.0 vs 27.0 months; P = .03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77-1.25; P = .89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from "curative" to "palliative" therapies. The survival of resected patients with LEM-HCC was significantly shorter than that of SEM-HCC (44.0 vs 78.0 months; P = .002), but liver resection provided the highest survival benefit in both groups compared to other treatments. CONCLUSIONS Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients.
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Affiliation(s)
- Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Barbara Penzo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Giulia Peserico
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Angela Imondi
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Anna Sartori
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Policlinico San Martino, Genova, Italy
| | - Antonella Forgione
- Internal Medicine-Piscaglia Unit, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Marco Zoli
- Department of Medical and Surgical Sciences, Internal Medicine-Zoli Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Andrea Olivani
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Francesco Azzaroli
- Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Science, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Filippo Oliveri
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine, University of Pisa, Pisa, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy
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13
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Vitale A, Farinati F, Pawlik TM, Frigo AC, Giannini EG, Napoli L, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Virdone R, Marra F, Felder M, Morisco F, Benvegnù L, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Missale G, Masotto A, Nardone G, Colecchia A, Bernardi M, Trevisani F, Cillo U. The concept of therapeutic hierarchy for patients with hepatocellular carcinoma: A multicenter cohort study. Liver Int 2019; 39:1478-1489. [PMID: 31131974 DOI: 10.1111/liv.14154] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Italian Liver Cancer (ITA.LI.CA) prognostic system for patients with hepatocellular carcinoma (HCC) has recently been proposed and validated. We sought to explore the relationship among the ITA.LI.CA prognostic variables (ie tumour stage, functional score based on performance status and Child-Pugh score, and alpha-fetoprotein), treatment selection and survival outcome in HCC patients. PATIENTS AND METHODS We analysed 4,867 consecutive HCC patients undergoing six main treatment strategies (liver transplantation, LT; liver resection, LR; ablation, ABL; intra-arterial therapy, IAT; Sorafenib, SOR; and best supportive care, BSC) and enrolled during 2002-2015 in a multicenter Italian database. In order to control pretreatment imbalances in observed variables, a machine learning methodology was used and inverse probability of treatment weights (IPTW) was calculated. An IPTW-adjusted multivariate survival model that included ITA.LI.CA prognostic variables, treatment period and treatment strategy was then developed. The survival benefit of HCC treatments was described as a hazard ratio (95% confidence interval), using BSC as a reference value and as predicted median survival. RESULTS After the IPTW, the six treatment groups became well balanced for most baseline characteristics. In the IPTW-adjusted multivariate survival model, treatment strategy was found to be the strongest survival predictor, irrespective of ITA.LI.CA prognostic variables and treatment period. The survival benefit of different therapies over BSC was: LT = 0.19 (0.18-0.20); RES = 0.40 (0.37-0.42); ABL 0.42 (0.40-0.44); IAT = 0.58 (0.55-0.61); SOR = 0.92 (0.87-0.97). This multivariate model was then used to predict median survival for each therapy within each ITA.LI.CA stage. CONCLUSION The concept of therapeutic hierarchy was established within each ITA.LI.CA stage.
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Affiliation(s)
- Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | | | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, University of Genoa, Genoa, Italy
| | - Lucia Napoli
- Division of Internal Medicine, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | - Gian Ludovico Rapaccini
- Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Di Marco
- Division of Medicine, Bolognini Hospital, Seriate, Italy
| | | | - Marco Zoli
- Division of Internal Medicine, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Franco Borzio
- Division of Radiology, Department of Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Rodolfo Sacco
- Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cabibbo
- Division of Gastroenterology, Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Roberto Virdone
- Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Fabio Marra
- Internal Medicine and Hepatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Martina Felder
- Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy
| | - Filomena Morisco
- Division of Gastroenterology, Department of Medicine and Surgery, University of Naples, "Federico II", Naples, Italy
| | - Luisa Benvegnù
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Gabriele Missale
- Division of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Hepato-Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Napoli, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Department of Surgical and Medical sciences, Alma Mater Studiorum-Università of Bologna, Bologna, Italy
| | - Mauro Bernardi
- Division of Semeiotics, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Franco Trevisani
- Division of Semeiotics, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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14
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Morisco F, Guarino M, Valvano MR, Auriemma F, Farinati F, Giannini EG, Ciccarese F, Tovoli F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Felder M, Benvengù L, Gasbarrini A, Svegliati Baroni G, Foschi FG, Biasini E, Masotto A, Virdone R, Marra F, Caporaso N, Trevisani F. Metabolic disorders across hepatocellular carcinoma in Italy. Liver Int 2018; 38:2028-2039. [PMID: 29745475 DOI: 10.1111/liv.13877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/30/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Metabolic disorders are well-known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its aetiology. METHODS We analysed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analysed: BMI, diabetes, arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia. According to these features, patients were divided into 3 groups: 0-1, 2 and 3-5 metabolic features. RESULTS As compared with patients with 0-1 metabolic features, patients with 3-5 features showed lower percentage of HCC diagnosis on surveillance (P = .021), larger tumours (P = .038), better liver function (higher percentage of Child-Pugh class A [P = .007] and MELD < 10 [P = .003]), higher percentage of metastasis (P = .024) and lower percentage of portal vein thrombosis (P = .010). The BCLC stage and treatment options were similar among the 3 groups, with the exception of a less frequent access to loco-regional therapies for BCLC stage B patients with 3-5 features (P = .012). Overall survival and survival according to BCLC stage and/or treatment did not significantly differ among the 3 groups. Only using a probabilistic sensitivity analysis, diabetic patients showed a lower survival (P = .046). MELD score, HCC morphology, nodule size, BCLC stage, portal vein thrombosis and metastasis were independent predictors of lead-time adjusted survival. CONCLUSIONS Our "real world" study suggests that metabolic disorders shape the clinical presentation of HCC but do not seem to play a major role in setting patient survival.
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Affiliation(s)
- Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria R Valvano
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Francesco Auriemma
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Fabio Farinati
- Section of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department Internal Medicine, Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Francesco Tovoli
- Internal Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Gian Ludovico Rapaccini
- Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Di Marco
- Division of Medicine, Bolognini Hospital, Seriate, Italy
| | | | - Marco Zoli
- Internal Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Franco Borzio
- Division of Radiology, Department of Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Rodolfo Sacco
- Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy
| | - Martina Felder
- Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy
| | - Luisa Benvengù
- Medical Unit, Department of Clinical and Experimental Medicine, University of Padua, Paadua, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesco G Foschi
- Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy
| | - Elisabetta Biasini
- Division of Infectious Diseases and Hepatology, Parma University Hospital, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Roberto Virdone
- Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Fabio Marra
- Department of Clinical and Experimental Medicine, Internal Medicine and Hepatology, University of Firenze, Firenze, Italy
| | - Nicola Caporaso
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Franco Trevisani
- Semeiotica Medica Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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15
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Vitale A, Farinati F, Noaro G, Burra P, Pawlik TM, Bucci L, Giannini EG, Faggiano C, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Virdone R, Marra F, Felder M, Morisco F, Benvegnù L, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Nardone G, Colecchia A, Fornari F, Marignani M, Vicari S, Bortolini E, Cozzolongo R, Grasso A, Aliberti C, Bernardi M, Frigo AC, Borzio M, Trevisani F, Cillo U. Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study. Hepatology 2018; 68:1232-1244. [PMID: 30048016 DOI: 10.1002/hep.30185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/19/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively). CONCLUSION Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.
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Affiliation(s)
- Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giulia Noaro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH
| | - Laura Bucci
- Department of Medical and Surgical Sciences, Division of Semeiotics, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Policlinico San Martino, Genoa, Italy
| | - Chiara Faggiano
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | | | - Gian Lodovico Rapaccini
- Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Di Marco
- Division of Medicine, Bolognini Hospital, Seriate, Italy
| | | | - Marco Zoli
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Franco Borzio
- Department of Medicine, Division of Radiology, Fatebenefratelli Hospital, Milan, Italy
| | - Rodolfo Sacco
- Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cabibbo
- Biomedical Department of Internal and Specialistic Medicine, Division of Gastroenterology, University of Palermo, Palermo, Italy
| | - Roberto Virdone
- Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Fabio Marra
- Internal Medicine and Hepatology, Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Martina Felder
- Bolzano Regional Hospital, Division of Gastroenterology, Bolzano, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Unit of Gastroenterology and Hepatology, University of Naples, "Federico II," Naples, Italy
| | - Luisa Benvegnù
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Andrea Olivani
- Division of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples "Federico II," Naples, Italy
| | - Antonio Colecchia
- Department of Surgical and Medical Sciences, Gastroenterology Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Fabio Fornari
- Gastroenterologia, Ospedale Saliceto, Piacenza, Italy
| | - Massimo Marignani
- UOS Malattie delle vie Biliari e del Fegato, UOC malattie dell'Apparato Digerente e del Fegato, AO S.Andrea, Università "Sapienza," Rome, Italy
| | - Susanna Vicari
- U.O.C. Gastroenterologia, Ospedale Bentivoglio, Bologna, Italy
| | - Emanuela Bortolini
- U.O. Medicina VI Epatologia e Gastroenterologia, Ospedale San Paolo, Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Mauro Bernardi
- Department of Medical and Surgical Sciences, Division of Semeiotics, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | | | - Mauro Borzio
- U.O.C. Gastroenterologia, ASST Melegnano-Martesana, Melegnano, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Division of Semeiotics, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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16
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Carr BI, Giannelli G, Guerra V, Giannini EG, Farinati F, Rapaccini GL, Marco MD, Zoli M, Caturelli E, Masotto A, Virdone R, Sacco R, Trevisani F. Plasma cholesterol and lipoprotein levels in relation to tumor aggressiveness and survival in HCC patients. Int J Biol Markers 2018; 33:423-431. [PMID: 29874983 DOI: 10.1177/1724600818776838] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS: Hepatocellular carcinoma is associated with several chronic liver diseases, especially chronic hepatitis B virus, hepatitis C virus, and alcoholism. It is increasingly appreciated that obesity/metabolic syndrome is also associated with chronic liver disease and subsequent hepatocellular carcinoma. METHODS: We retrospectively investigated the serum lipid profiles in a large hepatocellular carcinoma cohort, associated predominantly with the hepatitis B virus, hepatitis C virus, alcohol or nonalcoholic steatohepatitis. The cohort was examined both as a whole, as well as stratified by etiology. RESULTS: We found significant associations between parameters of hepatocellular carcinoma biology such as maximum tumor diameter, portal vein thrombosis, tumor multifocality or alpha-fetoprotein levels and individual lipid components, including total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides and body mass index. In a final multiple linear regression model considering all lipid variables together, only high-density lipoprotein cholesterol was significantly associated with the tumor Tumor Aggressiveness Index. High-density lipoprotein cholesterol was found to have a statistically higher hazard ratio for death than low high-density lipoprotein cholesterol levels (Cox). On examination by etiological group, alpha-fetoprotein levels were significantly higher in patients with hepatitis C virus compared to those with alcohol or nonalcoholic steatohepatitis, but maximum tumor diameter, tumor multifocality and portal vein thrombosis were similar across etiological groups. Nonalcoholic steatohepatitis patients had significantly less cirrhosis than other groups and hepatitis B virus patients had significantly higher cholesterol and low-density lipoprotein cholesterol levels than hepatitis C virus patients. CONCLUSIONS: This is the first report, to our knowledge, of a relationship between serum lipid parameters and indices of hepatocellular carcinoma growth, invasion and aggressiveness, as well as with survival.
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Affiliation(s)
- Brian I Carr
- 1 Izmir Biomedicine and Genome Institute (iBG), Dokuz Eylul University, Izmir, Turkey
| | - Gianluigi Giannelli
- 2 National Institute of Digestive Diseases, IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | - Vito Guerra
- 2 National Institute of Digestive Diseases, IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | - Edoardo G Giannini
- 3 Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Italy
| | - Fabio Farinati
- 4 Department of Surgical Science and Gastroenterology, Gastroenterology Unit, University of Padua, Italy
| | | | - Maria Di Marco
- 6 Division of Medicine, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - Marco Zoli
- 7 Department of Medical and Surgical Science, Internal Medicine Unit, Alma Mater Studiorum, University of Bologna, Italy
| | | | - Alberto Masotto
- 9 Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Roberto Virdone
- 10 Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Rodolfo Sacco
- 11 Unita Operativa Medicina interna 2, Ospedali Riuniti, Cervello, Palermo, Italy and Metabolic Diseases, Pisa University Hospital, Pisa, Italy
| | - Franco Trevisani
- 12 Department of Medical Surgical Sciences, Medical Semiotics Unit, Alma Mater Studiorum, University of Bologna, Italy
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17
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Giannini EG, Bucci L, Garuti F, Brunacci M, Lenzi B, Valente M, Caturelli E, Cabibbo G, Piscaglia F, Virdone R, Felder M, Ciccarese F, Foschi FG, Sacco R, Svegliati Baroni G, Farinati F, Rapaccini GL, Olivani A, Gasbarrini A, Di Marco M, Morisco F, Zoli M, Masotto A, Borzio F, Benvegnù L, Marra F, Colecchia A, Nardone G, Bernardi M, Trevisani F. Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice. Hepatology 2018; 67:1784-1796. [PMID: 29159910 DOI: 10.1002/hep.29668] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/22/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022]
Abstract
UNLABELLED The Barcelona Clinic Liver Cancer (BCLC) advanced stage (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population, where sorafenib alone is the recommended treatment. In this study, our aim was to assess treatment and overall survival (OS) of BCLC C patients subclassified according to clinical features (performance status [PS], macrovascular invasion [MVI], extrahepatic spread [EHS] or MVI + EHS) determining their allocation to this stage. From the Italian Liver Cancer database, we analyzed 835 consecutive BCLC C patients diagnosed between 2008 and 2014. Patients were subclassified as: PS1 alone (n = 385; 46.1%), PS2 alone (n = 146; 17.5%), MVI (n = 224; 26.8%), EHS (n = 51; 6.1%), and MVI + EHS (n = 29; 3.5%). MVI, EHS, and MVI + EHS patients had larger and multifocal/massive HCCs and higher alpha-fetoprotein (AFP) levels than PS1 and PS2 patients. Median OS significantly declined from PS1 (38.6 months) to PS2 (22.3 months), EHS (11.2 months), MVI (8.2 months), and MVI + EHS (3.1 months; P < 0.001). Among MVI patients, OS was longer in those with peripheral than with central (portal trunk) MVI (11.2 vs. 7.1 months; P = 0.005). The most frequent treatments were: curative approaches in PS1 (39.7%), supportive therapy in PS2 (41.8%), sorafenib in MVI (39.3%) and EHS (37.3%), and best supportive care in MVI + EHS patients (51.7%). Independent prognostic factors were: Model for End-stage Liver Disease score, Child-Pugh class, ascites, platelet count, albumin, tumor size, MVI, EHS, AFP levels, and treatment type. CONCLUSION BCLC C stage does not identify patients homogeneous enough to be allocated to a single stage. PS1 alone is not sufficient to include a patient into this stage. The remaining patients should be subclassified according to PS and tumor features, and new patient-tailored therapeutic indications are needed. (Hepatology 2018;67:1784-1796).
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Affiliation(s)
- Edoardo Giovanni Giannini
- Department of Internal Medicine, Gastroenterology Unit, San Martino Polyclinic, University of Genova, Genova, Italy
| | - Laura Bucci
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Francesca Garuti
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Matteo Brunacci
- Department of Internal Medicine, Gastroenterology Unit, San Martino Polyclinic, University of Genova, Genova, Italy
| | - Barbara Lenzi
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Matteo Valente
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Eugenio Caturelli
- Operative Unit of Gastroenterology, Belcolle Hospital, Viterbo, Italy
| | - Giuseppe Cabibbo
- Biomedical Department of Internal and Specialistic Medicine, Gastroenterology, Palermo, Italy
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, Internal Medicine Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Roberto Virdone
- Biomedical Department of Internal and Specialistic Medicine, Internal Medicin 2 Unit, Villa Sofia Hospital Agency Riuniti Hospitals-Cervello, Palermo, Italy
| | - Martina Felder
- Gastroenterology, Physiopathology and Digestive Endoscopy, Central Hospital of Bolzano, Bolzano, Italy
| | | | | | - Rodolfo Sacco
- Gastroenterology and Metabolic Diseases Unit, Hospital-University Agency of Pisa, Pisa, Italy
| | | | - Fabio Farinati
- Department of Surgical and Gastroenterological Sciences, Gastroenterology, University of Padova, Italy
| | | | - Andrea Olivani
- Department of Oncohematology and Internal Medicine, Infection diseases and Hepatology Unit, Parma, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit-Gemelli, Department of Internal Medicine, Rome, Italy
| | - Maria Di Marco
- Medicine Division, Bolognini Hospital Agency, Seriate, Italy
| | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical and Sperimental Medicine, Naples, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, Zoli Internal Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Alberto Masotto
- Gastroenterology, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Franco Borzio
- Department of Internal Medicine and Hepatology, Fatebenefratelli Hospital, Milan, Italy
| | - Luisa Benvegnù
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Fabio Marra
- Internal Medicine and Hepatology, Department of Sperimental and Clinical Medicine, Florence, Italy
| | - Antonio Colecchia
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Gerardo Nardone
- Department of Clinical and Surgical Medicine-Federico II University, Naples, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotica Medica Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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18
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Pecorelli A, Lenzi B, Gramenzi A, Garuti F, Farinati F, Giannini EG, Ciccarese F, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Felder M, Morisco F, Gasbarrini A, Baroni GS, Foschi FG, Biasini E, Masotto A, Virdone R, Bernardi M, Trevisani F. Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma. Liver Int 2017; 37:423-433. [PMID: 27566596 DOI: 10.1111/liv.13242] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The Barcelona Clinic Liver Cancer intermediate stage (BCLC-B) of hepatocellular carcinoma (HCC) includes extremely heterogeneous patients in terms of tumour burden and liver function. Transarterial-chemoembolization (TACE) is the first-line treatment for these patients although it may be risky/useless for someone, while others could undergo curative treatments. This study assesses the treatment type performed in a large cohort of BCLC-B patients and its outcome. METHODS Retrospective analysis of 485 consecutive BCLC-B patients from the ITA.LI.CA database diagnosed with naïve HCC after 1999. Patients were stratified by treatment. RESULTS 29 patients (6%) were lost to follow-up before receiving treatment. Treatment distribution was: TACE (233, 51.1%), curative treatments (145 patients, 31.8%), sorafenib (18, 3.9%), other (39, 8.5%), best supportive care (BSC) (21, 4.6%). Median survival (95% CI) was 45 months (37.4-52.7) for curative treatments, 30 (24.7-35.3) for TACE, 14 (10.5-17.5) for sorafenib, 14 (5.2-22.7) for other treatments and 10 (6.0-14.2) for BSC (P<.0001). Independent prognosticators were gender and treatment. Curative treatments reduced mortality (HR 0.197, 95%CI: 0.098-0.395) more than TACE (HR 0.408, 95%CI: 0.211-0.789) (P<.0001) as compared with BSC. Propensity score matching confirmed the superiority of curative therapies over TACE. CONCLUSIONS In everyday practice TACE represents the first-line therapy in an half of patients with naïve BCLC-B HCC since treatment choice is driven not only by liver function and nodule characteristics, but also by contraindications to procedures, comorbidities, age and patient opinion. The treatment type is an independent prognostic factor in BCLC-B patients and curative options offer the best outcome.
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Affiliation(s)
- Anna Pecorelli
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Barbara Lenzi
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Annagiulia Gramenzi
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesca Garuti
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Fabio Farinati
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Padova, Italy
| | - Edoardo G Giannini
- Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy
| | | | - Fabio Piscaglia
- Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Gian Lodovico Rapaccini
- Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Roma, Italy
| | - Maria Di Marco
- Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - Eugenio Caturelli
- Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy
| | - Marco Zoli
- Dipartimento di Gastroenterologia e Medicina Interna, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Franco Borzio
- Dipartimento di Medicina, Unità di Radiologia, Ospedale Fatebenefratelli, Milano, Italy
| | - Rodolfo Sacco
- Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Cabibbo
- Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Gastroenterologia, Università di Palermo, Palermo, Italy
| | - Martina Felder
- Ospedale Regionale di Bolzano, Unità di Gastroenterologia, Bolzano, Italy
| | - Filomena Morisco
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Gastroenterologia, Università di Napoli "Federico II", Napoli, Italy
| | - Antonio Gasbarrini
- Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Roma, Italy
| | | | - Francesco G Foschi
- Dipartimento di Medicina Interna, Ospedale per gli Infermi di Faenza, Faenza, Italy
| | - Elisabetta Biasini
- Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Roberto Virdone
- Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Interna 2, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Mauro Bernardi
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Franco Trevisani
- Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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19
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Bucci L, Garuti F, Lenzi B, Pecorelli A, Farinati F, Giannini EG, Granito A, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cammà C, Virdone R, Marra F, Felder M, Morisco F, Benvegnù L, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Missale G, Masotto A, Nardone G, Colecchia A, Bernardi M, Trevisani F. The evolutionary scenario of hepatocellular carcinoma in Italy: an update. Liver Int 2017; 37:259-270. [PMID: 27427866 DOI: 10.1111/liv.13204] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Epidemiology of hepatocellular carcinoma is changing worldwide. This study aimed at evaluating the changing scenario of aetiology, presentation, management and prognosis of hepatocellular carcinoma in Italy during the last 15 years. METHODS Retrospective analysis of the ITA.LI.CA (Italian Liver Cancer) database including 5192 hepatocellular carcinoma patients managed in 24 centres from 2000 to 2014. Patients were divided into three groups according to the date of cancer diagnosis (2000-2004, 2005-2009 and 2010-2014). RESULTS The main results were as follows: (i) progressive patient aging; (ii) progressive expansion of non-viral cases and, namely, of "metabolic" hepatocellular carcinomas; (iii) increasing proportion of hepatocellular carcinoma diagnosed during a correct (semi-annual) surveillance programme; (iv) favourable cancer stage migration; (v) increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) improved overall survival (adjusted for the lead time in surveyed patients), particularly after 2009, of both viral and non-viral patients presenting with an early- or intermediate-stage hepatocellular carcinoma. CONCLUSIONS During the last 15 years several aetiological and clinical features of hepatocellular carcinoma patients have changed, as their management. The observed improvement of overall survival was owing both to the wider use of semi-annual surveillance, expanding the proportion of tumours that qualified for curative treatments, and to the improved outcome of loco-regional treatments.
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Affiliation(s)
- Laura Bucci
- Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesca Garuti
- Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Barbara Lenzi
- Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Anna Pecorelli
- Unità di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Fabio Farinati
- Unità di Gastroenterologia, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy
| | - Edoardo G Giannini
- Unità di Gastroenterologia, Dipartimento di Medicina Interna, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy
| | - Alessandro Granito
- Unità di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | | | - Gian Lodovico Rapaccini
- Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Rome, Italy
| | - Maria Di Marco
- Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - Eugenio Caturelli
- Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy
| | - Marco Zoli
- Unità di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Franco Borzio
- Unità di Radiologia, Dipartimento di Medicina, Ospedale Fatebenefratelli, Milan, Italy
| | - Rodolfo Sacco
- Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Calogero Cammà
- Unità di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - Roberto Virdone
- Divisione di Medicina Interna, Ospedale Villa Sofia - V. Cervello, Università di Palermo, Palermo, Italy
| | - Fabio Marra
- Medicina Interna ed Epatologia, Dipartimento di Medicina Sperimentale e Clinica - Università di Firenze, Firenze, Italy
| | - Martina Felder
- Unità di Gastroenterologia, Ospedale Regionale di Bolzano, Bolzano, Italy
| | - Filomena Morisco
- Unità di Gastroenterologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy
| | - Luisa Benvegnù
- Dipartimento di Medicina Molecolare, Università di Padova, Padua, Italy
| | - Antonio Gasbarrini
- Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy
| | - Gianluca Svegliati-Baroni
- Dipartimento di Gastroenterologia, Gastroenterologia, Politecnico-Università delle Marche, Ancona, Italy
| | | | - Gabriele Missale
- Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Masotto
- Unità di Gastroenterologia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gerardo Nardone
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Epato-Gastroenterologia, Università di Napoli "Federico II", Naples, Italy
| | - Antonio Colecchia
- Unità di Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Mauro Bernardi
- Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Franco Trevisani
- Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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Carr BI, Guerra V, Giannini EG, Farinati F, Ciccarese F, Rapaccini GL, Di Marco M, Benvegnù L, Zoli M, Borzio F, Caturelli E, Masotto A, Trevisani F. A Liver Index and its Relationship to Indices of HCC Aggressiveness. J Integr Oncol 2016; 5:178. [PMID: 28580457 PMCID: PMC5450974 DOI: 10.4172/2329-6771.1000178] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A Hepatocellular (HCC) Aggressiveness Index was recently constructed, consisting of the sum of the scores for the 4 clinical parameters of maximum tumor size, multifocality, presence of portal vein thrombus and blood alphafetoprotein levels. It was observed that there was an association with several liver function tests. We have now formed a Liver Index from the 4 liver parameters with the highest hazard ratios with respect to HCC aggressiveness, namely: blood total bilirubin, gamma glutamyl transpeptidase (GGTP), albumin and platelet levels (cirrhosis surrogate). We found that the scores for the Liver Index related significantly to survival, but also to the Aggressiveness Index and to its individual HCC components as well as showing significant trends with the components. These results support the hypothesis that liver function is not only an important prognostic factor in HCC patients, but may also be involved in HCC biology and aggressiveness. Blood albumin, GGTP, albumin and platelet levels were used to create a Liver Index that related significantly to parameters of HCC aggressiveness.
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Affiliation(s)
- Brian I Carr
- Izmir Biomedicine and Genome Center, Dokuz Eylul University, Turkey and Lusaka Apex Medical University, Zambia
| | - Vito Guerra
- Department of Clinical Trials and Epidemiology, IRCCS de Bellis, Castellana Grotte, Italy
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Italy
| | - Fabio Farinati
- Department of Surgical Science and Gastroenterology, Gastroenterology Unit, University of Padua, Italy
| | | | | | - Maria Di Marco
- Division of Medicine, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - Luisa Benvegnù
- Department of Clinical and Experimental Medicine, Medical Unit, University of Padua, Italy
| | - Marco Zoli
- Department of Medical and Surgical Science, Internal Medicine Unit, Alma Mater Studiorum, University of Bologna, Italy
| | - Franco Borzio
- Department of Medicine, Internal Medicine and Hepatology Unit, Ospedale Fatebenefratelli, Milan, Italy
| | | | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Franco Trevisani
- Department of Medical Surgical Sciences, Medical Semiotics Unit, Alma Mater Studiorum, University of Bologna, Italy
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21
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Carr BI, Pancoska P, Giannini EG, Farinati F, Ciccarese F, Rapaccini GL, Marco MD, Benvegnù L, Zoli M, Borzio F, Caturelli E, Chiaramonte M, Trevisani F. Identification of two clinical hepatocellular carcinoma patient phenotypes from results of standard screening parameters. Semin Oncol 2014; 41:406-414. [PMID: 25023357 DOI: 10.1053/j.seminoncol.2014.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Previous work has shown that two general processes contribute to hepatocellular cancer (HCC) prognosis: liver damage, monitored by indices such as blood bilirubin, prothrombin time (PT), and aspartate aminostransferase (AST); and tumor biology, monitored by indices such as tumor size, tumor number, presence of portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. These processes may affect one another, with prognostically significant interactions between multiple tumor and host parameters. These interactions form a context that provide personalization of the prognostic meaning of these factors for every patient. Thus, a given level of bilirubin or tumor diameter might have a different significance in different personal contexts. We previously applied network phenotyping strategy (NPS) to characterize interactions between liver function indices of Asian HCC patients and recognized two clinical phenotypes, S and L, differing in tumor size and tumor nodule numbers. Our aim was to validate the applicability of the NPS-based HCC S/L classification on an independent European HCC cohort, for which survival information was additionally available. Four sets of peripheral blood parameters, including AFP-platelets, derived from routine blood parameter levels and tumor indices from the ITA.LI.CA database, were analyzed using NPS, a graph-theory-based approach that compares personal patterns of complete relationships between clinical data values to reference patterns with significant association to disease outcomes. Without reference to the actual tumor sizes, patients were classified by NPS into two subgroups with S and L phenotypes. These two phenotypes were recognized using solely the HCC screening test results, consisting of eight common blood parameters, paired by their significant correlations, including an AFP-platelets relationship. These trends were combined with patient age, gender, and self-reported alcoholism into NPS personal patient profiles. We subsequently validated (using actual scan data) that patients in L phenotype group had 1.5× larger mean tumor masses relative to S, P = 6 × 10(-16). Importantly, with the new data, liver test pattern-identified S-phenotype patients had typically 1.7× longer survival compared to L-phenotype patients. NPS integrated the liver, tumor, and basic demographic factors. Cirrhosis-associated thrombocytopenia was typical for smaller S tumors. In L tumor phenotype, typical platelet levels increased with the tumor mass. Hepatic inflammation and tumor factors contributed to more aggressive L tumors, with parenchymal destruction and shorter survival. NPS provides integrative interpretation for HCC behavior, identifying two tumor and survival phenotypes by clinical parameter patterns. The NPS classifier is provided as an Excel tool. The NPS system shows the importance of considering each tumor marker and parameter in the total context of all the other parameters of an individual patient.
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Affiliation(s)
- Brian I Carr
- Department of Liver Tumor Biology IRCCS de Bellis, National Institute for Digestive Diseases, Castellana Grotte , BA, Italy
| | - Petr Pancoska
- Center for Craniofacial and Dental Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edoardo G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa
| | - Fabio Farinati
- Department of Surgical Science and Gastroenterology, Gastroenterology Unit, University of Padua
| | | | | | - Maria Di Marco
- Division of Medicine, Azienda Ospedaliera Bolognini, Seriate
| | - Luisa Benvegnù
- Departiment of Clinical and Experimental Medicine, Medical Unit, University of Padua
| | - Marco Zoli
- Department of Medical and Surgical Science, Internal Medicine Unit, Alma Mater Studiorum - University of Bologna
| | - Franco Borzio
- Department of Medicine, Internal Medicine and Hepatology Unit, Ospedale Fatebenefratelli, Milan
| | | | | | - Franco Trevisani
- Department of Medical Surgical Sciences, Medical Semiotics Unit, Alma Mater Studiorum - University of Bologna, Italy
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Carr BI, Guerra V, Giannini EG, Farinati F, Ciccarese F, Ludovico Rapaccini G, Di Marco M, Benvegnù L, Zoli M, Borzio F, Caturelli E, Chiaramonte M, Trevisani F. Association of abnormal plasma bilirubin with aggressive hepatocellular carcinoma phenotype. Semin Oncol 2014; 41:252-8. [PMID: 24787296 DOI: 10.1053/j.seminoncol.2014.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cirrhosis-related abnormal liver function is associated with predisposition to hepatocellular carcinoma (HCC). It features in several HCC classification systems and is an HCC prognostic factor. The aim of the present study was to examine the phenotypic tumor differences in HCC patients with normal or abnormal plasma bilirubin levels. A 2,416-patient HCC cohort was studied and dichotomized into normal and abnormal plasma bilirubin groups. Their HCC characteristics were compared for tumor aggressiveness features, namely, blood alpha-fetoprotein (AFP) levels, tumor size, presence of portal vein thrombosis (PVT) and tumor multifocality. In the total cohort, elevated bilirubin levels were associated with higher AFP levels, increased PVT and multifocality, and lower survival, despite similar tumor sizes. When different tumor size terciles were compared, similar results were found, even among patients with small tumors. A multiple logistic regression model for PVT or tumor multifocality showed increased odds ratios for elevated levels of gamma glutamyl transpeptidase (GGTP), bilirubin, and AFP and for larger tumor sizes. We conclude that HCC patients with abnormal bilirubin levels had worse prognosis than patients with normal bilirubin. They also had an increased incidence of PVT and tumor multifocality, and higher AFP levels, in patients with both small and larger tumors. The results show an association between bilirubin levels and indices of HCC aggressiveness.
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Affiliation(s)
- Brian I Carr
- Liver Tumor Program, IRCCS de Bellis, Castellana Grotte, Italy.
| | - Vito Guerra
- Liver Tumor Program, IRCCS de Bellis, Castellana Grotte, Italy
| | - Edoardo G Giannini
- Departiment of Internal Medicine, Gastroenterology Unit, University of Genoa, Italy
| | - Fabio Farinati
- Departiment of Surgical Science and Gastroenterology, Gastroenterology Unit, University of Padua, Italy
| | | | | | - Maria Di Marco
- Division of Medicine, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - Luisa Benvegnù
- Departiment of Clinical and Experimental Medicine, Medical Unit, University of Padua, Italy
| | - Marco Zoli
- Department of Medical and Surgical Science, Internal Medicine Unit, Alma Mater Studiorum-University of Bologna, Italy
| | - Franco Borzio
- Department of Medicine, Internal Medicine and Hepatology Unit, Ospedale Fatebenefratelli, Milan, Italy
| | | | - Maria Chiaramonte
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Franco Trevisani
- Department of Medical Surgical Sciences, Medical Semiotics Unit, Alma Mater Studiorum-University of Bologna, Italy
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Di Marco M. Overview of the main methods used to combine proteins with nanosystems: absorption, bioconjugation, and encapsulation. Int J Nanomedicine 2009. [DOI: 10.2147/ijn.s6458] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Marchi A, Chiossi M, Renier S, Baratta A, Botarelli P, Cardoni G, Crichiutti G, Cuomo B, Da Dalt L, Di Marco M, Donegà S, Lubrano R, Peisino MG, Pescarmona M, Vietti Ramus M, Signore L, Turbacci M, Turrisi A, Francesco A, Valenti M, Vitale A, Zannino L, Knezevitch M, Valent F. [Peculiar features of childhood poisoning and in the maternal-fetal period]. Ann Ist Super Sanita 2006; 42:318-24. [PMID: 17124356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Acute toxic exposures in childhood are quite a frequent event in Paediatric Emergency Medicine. Despite that, there are few papers about clinical toxicology in children, at least in Italy. This paper is the first that takes into account both epidemiological aspects and clinical features of acute poisoning in children on a national basis. Collected data show the increased use of activated charcoal as a treatment and the use of the short stay observation unit as an appropriate answer to the real clinical situation, although some aspects are still controversial. It will be necessary to reconsider the whole matter widening the number of participating centres, so that the most controversial aspects may be clarified.
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Affiliation(s)
- Alberto Marchi
- Unità Operativa, Pronto Soccorso, Primo Accoglimento, Centro Antiveleni, IRCCS Burlo Garofano, Trieste
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Molinari AC, Haupt R, Saracco P, Di Marco M, Castagnola E, Fratino G. Urokinase for restoring patency of malfunctioning or blocked central venous catheters in children with hemato-oncological diseases. Support Care Cancer 2004; 12:840-3. [PMID: 15365798 DOI: 10.1007/s00520-004-0616-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2003] [Accepted: 02/11/2004] [Indexed: 12/01/2022]
Abstract
GOALS OF WORK To evaluate differences in success rate between two dosages of intraluminal urokinase (IL-UK) for treatment of withdraw occlusion in central venous catheters (CVC) and to confirm the efficacy of a salvage protocol with low-dose systemic urokinase (S-UK) in case of failure of IL-UK or of complete catheter obstruction. PATIENTS AND METHODS All malfunctioning or occluded partially implanted indwelling catheters inserted in a 29-month period in children with cancer at two tertiary care centers (Genoa and Turin) in Italy were eligible for this study. In cases of withdraw occlusion, IL-UK was used as first-line treatment with different schedules of administration in the two centers: a 5,000 IU/ml dose was used in Genoa and a 25,000 IU/ml dose in Turin (Protocol A). In case of failure of the front-line protocol or in case of complete CVC occlusion, S-UK at 1,000 IU/kg per hour for 3 h was used as a salvage protocol in both centers (Protocol B). MAIN RESULTS There were 81 episodes of malfunction and three of occlusion recorded in 68 CVCs. Protocol A was successful in 75 (92.5%) of the malfunction episodes. In particular, the dose of 5,000 IU of IL-UK was successful in 42 (89%) CVCs while the 25,000 IU dose resolved 33 (97%) of the episodes (not significant). The six patients with CVC refractory to IL-UK and the three subjects with complete CVC occlusion were treated with S-UK. Patency was obtained in seven cases (78%); the remaining two catheters had to be removed. CONCLUSIONS We found that 5,000 IU of IL-UK were as effective as 25,000 IU to resolve withdrawal occlusion in partially implanted CVCs and that systemic treatment with urokinase may rescue a significant proportion of CVCs refractory to IL-UK or that are apparently completely occluded.
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Affiliation(s)
- Angelo Claudio Molinari
- Section of Thrombosis and Haemostasis, Department of Pediatric Hematology and Oncology, G. Gaslini Children's Hospital, Genoa, Italy
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Pertusa S, Marco MD, Quirce F, Bueno JM. [Sexual dysfunction due to captopril and amlodipine]. Aten Primaria 1994; 13:331. [PMID: 8204787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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27
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Bueno JM, Marco MD, Leal A, Orozco D, Mira JJ. [An evaluation study of a scale of diabetological education in primary care]. Aten Primaria 1993; 11:344-8. [PMID: 8499549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To devise and evaluate a scale of measurement which would permit evaluation at primary care level, of the knowledge that diabetic patients have of diabetes. Secondly, to ascertain the level of knowledge of the sample of diabetic patients attending the Xixona Health Centre. DESIGN Non-longitudinal, observational, descriptive study. SETTING Primary health care (health centre). MEASUREMENTS AND MAIN RESULTS The degree of internal consistency of the diabetes scale of knowledge (DISK) attained a Cronbach Alpha value of 0.87. The coefficients of correlation of each of the factors--defined a priori (general knowledge, diet, exercise, hygiene and self-regulation)--oscillated between 0.77 and 0.83. The Garret index of corrected difficulty was at 0.64. The homogeneity of each item with the questionnaire showed values above 0.31. The reliability measured by means of the KR20 index was 0.86. The odd-even coefficient of reliability was at 0.89. The mean level of correct answers was 70%. A relation was found between the level of knowledge and the variables age and years the patient had been subject to the condition. No relation was found with the treatment, sex, glycaemia or HbA1C level, nor educational level. CONCLUSIONS The indices obtained by the scale can be considered to be judiciously acceptable, both in terms of their internal consistency and their ability to characterise. The DISK (ECODI) is, then, a valuable tool in the field of primary health care.
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Affiliation(s)
- J M Bueno
- Departamento de Medicina, Universidad de Alicante
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