title: Application of the Intermediate-Stage Subclassification to Patients With Untreated Hepatocellular Carcinoma.
abstract: OBJECTIVE
  The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group.
  
  
  METHODS
  We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages.
  
  
  RESULTS
  Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P<0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P<0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P<0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival.
  
  
  CONCLUSIONS
  The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients.
authors.affiliation: Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Moscatelli
authors.affiliation: Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Pellegatta
authors.affiliation: Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Chirurgia Epatobiliare e dei Trapianti Epatici, Università di Padova, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Divisione di Chirurgia, Policlinico San Marco, Zingonia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.affiliation: Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Roma, Italy.
authors.forename: Gian Lodovico
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Marco
authors.affiliation: Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.affiliation: Dipartimento di Medicina, Unità di Radiologia, Ospedale Fatebenefratelli, Milano, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Gastroenterologia, Università di Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.affiliation: Ospedale Regionale di Bolzano, Unità di Gastroenterologia, Bolzano, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.affiliation: Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unità di Gastroenterologia, Università di Napoli 'Federico II', Napoli, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.affiliation: Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Missale
authors.affiliation: Dipartimento di Medicina Interna, Ospedale per gli Infermi di Faenza, Faenza, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Foschi
authors.affiliation: Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Roma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Clinica di Gastroenterologia, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Gianluca Svegliati
authors.initials: GS
authors.lastname: Baroni
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Interna 2, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Virdone
authors.affiliation: Unità di Gastroenterologia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Masotto
authors.affiliation: Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000145:classification* / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult