title: BCLC stage B hepatocellular carcinoma and transcatheter arterial chemoembolization: a 20-year survey by the Italian Liver Cancer group.
abstract: OBJECTIVE
  Significant proportion of Hepatocellular Carcinoma (HCC) cases are diagnosed in stage B of Barcelona Clinic Liver Cancer (BCLC) algorithm, in which the standard of care is Transcatheter Arterial ChemoEmbolization (TACE). We aimed to ascertain adherence to current guidelines, survival and prognostic factors in BCLC stage B patients.
  
  
  METHODS
  From 3027 HCC cases recruited from 1986 to 2008 by the Italian Liver Cancer group (2430 with data allowing a correct allocation in the BCLC system), a retrospective analysis was conducted on those diagnosed in BCLC stage B (405 patients, 17%). Statistics were performed with Kaplan-Meier (log rank) method and Cox multivariate analysis.
  
  
  RESULTS
  Median overall survival in BCLC stage B patients was 25 months (Confidence Interval - C.I. - 22-28 months) with a 5-year survival of 18%. Child-Pugh class, oesophageal varices and Alpha-foetoprotein (AFP) were the independent predictors of survival. TACE was applied in 40% of cases and did not offer the longest survival in comparison with surgical or percutaneous treatments (median 27 months vs. 37 and 36 months, respectively) (P < 0.001). BCLC stage B patients undergoing radical treatments were more frequently in Child-Pugh class A and had a significantly lower number of lesions; patients undergoing best supportive care were frequently in Child-Pugh class B and had a multifocal disease. Survival after TACE did not significantly increase over time.
  
  
  CONCLUSIONS
  In clinical practice, TACE cannot be considered the best approach for BCLC stage B patients who represent a heterogeneous population and are often suitable for more aggressive therapies, which lead to a better survival.
authors: Department of Surgery, Oncology and Gastroenterology, Section of Gastroenterology, University of Padua, Padua, Italy.
authors: Fabio
authors: F
authors: Farinati
authors: Veronica
authors: V
authors: Vanin
authors: Anna
authors: A
authors: Giacomin
authors: Caterina
authors: C
authors: Pozzan
authors: Umberto
authors: U
authors: Cillo
authors: Alessandro
authors: A
authors: Vitale
authors: Anna Maria
authors: AM
authors: Di Nolfo
authors: Paolo
authors: P
authors: Del Poggio
authors: Luisa
authors: L
authors: Benvegnu'
authors: Gianludovico
authors: G
authors: Rapaccini
authors: Marco
authors: M
authors: Zoli
authors: Franco
authors: F
authors: Borzio
authors: Edoardo G
authors: EG
authors: Giannini
authors: Eugenio
authors: E
authors: Caturelli
authors: Franco
authors: F
authors: Trevisani
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
keywords: BCLC algorithm; hepatocellular carcinoma; transcatheter arterial chemoembolization; treatment choice