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Web End = Dig Dis Sci (2015) 60:14651473 DOI 10.1007/s10620-014-3427-5
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Web End = Trend of Improving Prognosis of Hepatocellular Carcinoma in Clinical Practice: An Italian In-Field Experience
Mauro Borzio Elena Dionigi Angelo Rossini Anna Toldi Giampiero Francica
Fabio Fornari Andrea Salmi Fabio Farinati Susanna Vicari
Massimo Marignani Fulvia Terracciano Barbara Ginanni Rodolfo Sacco
Received: 13 August 2014 / Accepted: 2 November 2014 / Published online: 16 November 2014 Springer Science+Business Media New York 2014
AbstractBackground Recent data suggest that outcome of hepatocarcinoma is improving.
Aims In order to explore whether survival is also increasing in clinical practice, we compared two multi-center independent in-eld cohorts of cirrhotics with newly diagnosed HCCs.
Methods Cohort 1 (C1) consisted of 327 patients enrolled between January and December 1998, and cohort 2 (C2) included 826 patients enrolled between September 2008 and November 2012. Patients were stratied according to Child-Pugh score, MELD score, and HCC staged according to TNM, BCLC systems.
Results At baseline, C2 patients were signicantly older, with more frequent comorbidities and better liver function.
In C2, HCC was more frequently detected under regular ultrasound surveillance (P \ 0.001), BCLC early stages were more frequent, and rates of smaller and uni/paucinodular tumors were signicantly higher. Treatment of any type was more frequently offered to C2 patients (P \ 0.001). Proportion of patients treated by TACE increased, and radiofrequency ablation was the most used ablative treatment. Survival rate was signicantly higher in C2 being C1 and C2 survival at 13 years 7225 and 7544 %, respectively. Child-Pugh score A, BCLC stage A, single nodule, size B3 cm, belonging to cohort C2 and treatment per se independently predicted survival. Conclusions This in-eld study showed a trend on improved HCC outcomes over time, which seems to be mainly due to a better presentation thanks to the wider
M. Borzio (&) E. Dionigi
U.O.C. Gastroenterologia, A.O. Melegnano, Melegnano, Italy e-mail: [email protected]
E. Dionigie-mail: [email protected]
A. RossiniU.O.D. Epatologia, Ospedale Civile di Brescia, Brescia, Italy e-mail: [email protected]
A. ToldiU.O.C. Gastroenterologia, Ospedale Valduce, Como, Italy e-mail: [email protected]
G. FrancicaU.O....