Patients with Barcelona Clinic Liver Cancer Stages B and C Hepatocellular Carcinoma: Time for a Subclassification

被引:65
作者
Golfieri, Rita [1 ]
Bargellini, Irene [2 ]
Spreafico, Carlo [3 ]
Trevisani, Franco [4 ]
机构
[1] Alma Mater Studiorum Univ Bologna, S Orsola Malpighi Hosp, Dept Diagnost & Prevent Med, Radiol Unit, Bologna, Italy
[2] Pisa Univ Hosp, Intervent Radiol Unit, Pisa, Italy
[3] Ist Tumori Milan IRCCS Fdn, Dept Radiol, Intervent Radiol Unit, Milan, Italy
[4] Alma Mater Studiorum, Dept Med & Surg Sci, Div Semeiot, Bologna, Italy
关键词
Liver neoplasms; Intermediate-stage hepatocellular carcinoma; Advanced-stage hepatocellular carcinoma; Portal vein thrombosis; Subclassifications of Barcelona Clinic Liver Cancer stages B and C; ARTERIAL INFUSION CHEMOTHERAPY; PORTAL-VEIN THROMBOSIS; 7 STAGING SYSTEMS; TRANSARTERIAL CHEMOEMBOLIZATION; SURGICAL RESECTION; SURVIVAL ANALYSIS; SCORING SYSTEM; SORAFENIB; EFFICACY; SAFETY;
D O I
10.1159/000489791
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The Barcelona Clinic Liver Cancer (BCLC) intermediate and advanced stages (BCLC B and C) of hepatocellular carcinoma (HCC) both include heterogeneous populations. Patients classified as BCLC stage B present with different tumour burdens, and the recommended treatment is transarterial chemoembolization (TACE). A similar heterogeneity of tumour burden and liver function can be found among patients classified as BCLC stage C, which includes diverse clinical features (performance status [PS] 1-2), macrovascular invasion (MVI) including portal vein tumour (PVT) thrombosis, and/or extra-hepatic spread. Nonetheless, the anti-tumoural treatment formally recommended by Western guidelines is systemic therapy with sorafenib. Summary: Several proposals of subclassification for both these stages have been suggested in recent years, differentiating the more appropriate treatments for each substage. In particular, for BCLC stage C patients with PVT, therapeutic indications, clinical outcomes, and response to locoregional therapy are notably different in the presence of subsegmental, segmental or main PVT. Accordingly, liver resection and transarterial therapies, such as TACE or transarterial embolization (TAE) and Y-90-radioembolization (TARE), can be performed in locally advanced HCC with intrahepatic MVI according to its extent. In fact, surgery and TACE/TAE/TARE have no contraindications in the presence of PVT limited to the subsegmental or segmental branches in Child-Pugh class A patients, whereas only TARE should be utilized when there is lobar branch involvement. The presence of PS 1 should not be sufficient to allocate patients to the advanced stage since this would preclude any potential treatment for HCC. Patients should be properly classified as BCLC C only in cases of main portal trunk PVT, and treated according to the guidelines, provided that they belong to Child-Pugh class A. Key Messages: Subclassifications of BCLC B and C stages are urgently needed and require validation in order to guide clinicians towards the most effective treatment option. (C) 2018 S. Karger AG, Basel
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页码:78 / 91
页数:14
相关论文
共 78 条
[1]  
[Anonymous], 2018, HEPATOLOGY
[2]  
[Anonymous], 2018, J HEPATOL
[3]   Position paper of the Italian Association for the Study of the Liver (AISF): The multidisciplinary clinical approach to hepatocellular carcinoma [J].
Bolondi, Luigi ;
Cillo, Umberto ;
Colombo, Massimo ;
Craxi, Antonio ;
Farinati, Fabio ;
Giannini, Edoardo G. ;
Golfieri, Rita ;
Levrero, Massimo ;
Pinna, Antonio Daniele ;
Piscaglia, Fabio ;
Raimondo, Giovanni ;
Trevisani, Franco ;
Bruno, Raffaele ;
Caraceni, Paolo ;
Ciancio, Alessia ;
Coco, Barbara ;
Fraquelli, Mirella ;
Rendina, Maria ;
Squadrito, Giovanni ;
Toniutto, Pierluigi .
DIGESTIVE AND LIVER DISEASE, 2013, 45 (09) :712-723
[4]   Heterogeneity of Patients with Intermediate (BCLC B) Hepatocellular Carcinoma: Proposal for a Subclassification to Facilitate Treatment Decisions [J].
Bolondi, Luigi ;
Burroughs, Andrew ;
Dufour, Jean-Francois ;
Galle, Peter R. ;
Mazzaferro, Vincenzo ;
Piscaglia, Fabio ;
Raoul, Jean Luc ;
Sangro, Bruno .
SEMINARS IN LIVER DISEASE, 2012, 32 (04) :348-359
[5]   Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial [J].
Bruix, Jordi ;
Qin, Shukui ;
Merle, Philippe ;
Granito, Alessandro ;
Huang, Yi-Hsiang ;
Bodoky, Gyrogy ;
Pracht, Marc ;
Yokosuka, Osamu ;
Rosmorduc, Olivier ;
Breder, Valeriy ;
Gerolami, Rene ;
Masi, Gianluca ;
Ross, Paul J. ;
Song, Tianqiang ;
Bronowicki, Jean-Pierre ;
Ollivier-Hourmand, Isabelle ;
Kudo, Masatoshi ;
Cheng, Ann-Lii ;
Llovet, Josep M. ;
Finn, Richard S. ;
LeBerre, Marie-Aude ;
Baumhauer, Annette ;
Meinhardt, Gerold ;
Han, Guohong .
LANCET, 2017, 389 (10064) :56-66
[6]   Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma [J].
Bruix, Jordi ;
Reig, Maria ;
Sherman, Morris .
GASTROENTEROLOGY, 2016, 150 (04) :835-853
[7]   Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: Subanalyses of a phase III trial [J].
Bruix, Jordi ;
Raoul, Jean-Luc ;
Sherman, Morris ;
Mazzaferro, Vincenzo ;
Bolondi, Luigi ;
Craxi, Antonio ;
Galle, Peter R. ;
Santoro, Armando ;
Beaugrand, Michel ;
Sangiovanni, Angelo ;
Porta, Camillo ;
Gerken, Guido ;
Marrero, Jorge A. ;
Nadel, Andrea ;
Shan, Michael ;
Moscovici, Marius ;
Voliotis, Dimitris ;
Llovet, Josep M. .
JOURNAL OF HEPATOLOGY, 2012, 57 (04) :821-829
[8]   Management of Hepatocellular Carcinoma: An Update [J].
Bruix, Jordi ;
Sherman, Morris .
HEPATOLOGY, 2011, 53 (03) :1020-1022
[9]   The evolutionary scenario of hepatocellular carcinoma in Italy: an update [J].
Bucci, Laura ;
Garuti, Francesca ;
Lenzi, Barbara ;
Pecorelli, Anna ;
Farinati, Fabio ;
Giannini, Edoardo G. ;
Granito, Alessandro ;
Ciccarese, Francesca ;
Rapaccini, Gian Lodovico ;
Di Marco, Maria ;
Caturelli, Eugenio ;
Zoli, Marco ;
Borzio, Franco ;
Sacco, Rodolfo ;
Camma, Calogero ;
Virdone, Roberto ;
Marra, Fabio ;
Felder, Martina ;
Morisco, Filomena ;
Benvegnu, Luisa ;
Gasbarrini, Antonio ;
Svegliati-Baroni, Gianluca ;
Foschi, Francesco Giuseppe ;
Missale, Gabriele ;
Masotto, Alberto ;
Nardone, Gerardo ;
Colecchia, Antonio ;
Bernardi, Mauro ;
Trevisani, Franco .
LIVER INTERNATIONAL, 2017, 37 (02) :259-270
[10]   Feasibility of Sorafenib Combined with Local Radiotherapy in Advanced Hepatocellular Carcinoma [J].
Cha, Jihye ;
Seong, Jinsil ;
Lee, Ik Jae ;
Kim, Jun Won ;
Han, Kwang-Hyub .
YONSEI MEDICAL JOURNAL, 2013, 54 (05) :1178-1185