title: Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Anna
authors: A
authors: Pecorelli
authors: Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Barbara
authors: B
authors: Lenzi
authors: Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Annagiulia
authors: A
authors: Gramenzi
authors: Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Francesca
authors: F
authors: Garuti
authors: Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Padova, Italy.
authors: Fabio
authors: F
authors: Farinati
authors: Dipartimento di Medicina Interna, Unità di Gastroenterologia, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy.
authors: Edoardo G
authors: EG
authors: Giannini
authors: Divisione di Chirurgia, Policlinico San Marco, Zingonia, Italy.
authors: Francesca
authors: F
authors: Ciccarese
authors: Dipartimento di Scienze Mediche e Chirurgiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Fabio
authors: 0000-0001-8264-1845
authors: F
authors: Piscaglia
authors: Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Roma, Italy.
authors: Gian Lodovico
authors: GL
authors: Rapaccini
authors: Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy.
authors: Maria
authors: M
authors: Di Marco
authors: Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
authors: Eugenio
authors: E
authors: Caturelli
authors: Dipartimento di Gastroenterologia e Medicina Interna, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Marco
authors: M
authors: Zoli
authors: Dipartimento di Medicina, Unità di Radiologia, Ospedale Fatebenefratelli, Milano, Italy.
authors: Franco
authors: F
authors: Borzio
authors: Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors: Rodolfo
authors: R
authors: Sacco
authors: Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Gastroenterologia, Università di Palermo, Palermo, Italy.
authors: Giuseppe
authors: G
authors: Cabibbo
authors: Ospedale Regionale di Bolzano, Unità di Gastroenterologia, Bolzano, Italy.
authors: Martina
authors: M
authors: Felder
authors: Dipartimento di Medicina Clinica e Chirurgia, Unità di Gastroenterologia, Università di Napoli "Federico II", Napoli, Italy.
authors: Filomena
authors: F
authors: Morisco
authors: Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Roma, Italy.
authors: Antonio
authors: A
authors: Gasbarrini
authors: Clinica di Gastroenterologia, Università Politecnica delle Marche, Ancona, Italy.
authors: Gianluca Svegliati
authors: GS
authors: Baroni
authors: Dipartimento di Medicina Interna, Ospedale per gli Infermi di Faenza, Faenza, Italy.
authors: Francesco G
authors: FG
authors: Foschi
authors: Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors: Elisabetta
authors: E
authors: Biasini
authors: Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
authors: Alberto
authors: A
authors: Masotto
authors: Dipartimento Biomedico di Medicina Interna e Specialistica, Unità di Medicina Interna 2, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
authors: Roberto
authors: R
authors: Virdone
authors: Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Mauro
authors: M
authors: Bernardi
authors: Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors: Franco
authors: F
authors: Trevisani
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D018579:Patient Selection; D010671:Phenylurea Compounds / Q000627:therapeutic use; D057216:Propensity Score; D012189:Retrospective Studies; D000077157:Sorafenib; D059039:Standard of Care; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: 
  HCC
  ; BCLC-B; intermediate stage; treatment