title: Treatment of hepatocellular carcinoma in Child-Pugh B patients.
abstract: BACKGROUND
  The frequency with which patients in Child-Pugh B having hepatocellular carcinoma are treated following the international guidelines according to the Barcelona Clinic Liver Cancer stages is unknown.
  
  
  OBJECTIVE
  To investigate treatment allocation for Child-Pugh B patients in different tumour stages, with particular interest in the intermediate stage.
  
  
  METHODS
  Patients were retrospectively identified from a consecutively collected series. Treatment was carried out primarily according to the guidelines.
  
  
  RESULTS
  Of 86 Child-Pugh B patients, 45 were Barcelona early stage, of which the Child-Pugh scores were 46.7% B7, 33.3% B8, 20.0% B9; 27 patients were intermediate stage (B7 59.3%, B8 37.0% and B9 3.7% respectively), 12 were advanced (41.7% B7, 25.0% B8 and 33.3% B9) and 2 were terminal (both B9). In the intermediate stage, transarterial chemoembolization (or ablation) was performed in 68.8% of the Child-Pugh B7 patients, 50% of the B8 patients and 0% of the B9 patients. Median survival of the intermediate patients was 8.0 months (9.0 in B7 vs. 6.0 in -B8/B9, P=0.048). Survival of the intermediate stage patients undergoing chemoembolisation was 22.0 months in Child-Pugh B7 and 6.0 in B8.
  
  
  CONCLUSIONS
  Approximately half of the intermediate stage patients can undergo locoregional treatment with good survival when in the Child-Pugh B7. The Child-Pugh numeric score impacts survival, suggesting that this tumour stage be refined.
authors.affiliation: Division of Internal Medicine, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: fabio.piscaglia@unibo.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Eleonora
authors.initials: E
authors.lastname: Terzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Chiara
authors.initials: C
authors.lastname: Trimarchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Granito
authors.forename: Simona
authors.initials: S
authors.lastname: Leoni
authors.forename: Sara
authors.initials: S
authors.lastname: Marinelli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pini
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Hepatocellular carcinoma; Liver function; Transarterial chemoembolisation; Tumour staging systems