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Hepatectomy Versus Sorafenib in Advanced Nonmetastatic Hepatocellular Carcinoma: A Real-life Multicentric Weighted Comparison.
Famularo, Simone; Donadon, Matteo; Cipriani, Federica; Giuliante, Felice; Ferri, Silvia; Celsa, Ciro; Ferrero, Alessandro; Foschi, Francesco Giuseppe; Baiocchi, Gian Luca; Biasini, Elisabetta; Campani, Claudia; Valle, Raffaele Dalla; Pelizzaro, Filippo; Baroni, Gianluca Svegliati; Raimondo, Giovanni; Mega, Andrea; Chiarelli, Marco; Maestri, Marcello; Gasbarrini, Antonio; Jovine, Elio; Grazi, Gian Luca; Rapaccini, Gian Ludovico; Ruzzenente, Andrea; Morisco, Filomena; Sacco, Rodolfo; Memeo, Riccardo; Crespi, Michele; Antonucci, Adelmo; Bernasconi, Davide P; Romano, Fabrizio; Griseri, Guido; Aldrighetti, Luca; Torzilli, Guido; Trevisani, Franco.
Affiliation
  • Famularo S; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Donadon M; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
  • Cipriani F; School of Medicine and Surgery, University of Milan-Bicocca, Department of Surgery, San Gerardo Hospital, Monza, Italy.
  • Giuliante F; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Ferri S; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
  • Celsa C; Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Ferrero A; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Foschi FG; Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Baiocchi GL; Division of Gastroenterology and Hepatology, Department Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy.
  • Biasini E; Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I," Turin, Italy.
  • Campani C; Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.
  • Valle RD; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
  • Pelizzaro F; Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
  • Baroni GS; Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy.
  • Raimondo G; Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Mega A; Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Padua University, Padua, Italy.
  • Chiarelli M; Liver Injury and Transplant Unit, Polytechnic University of Marche, Ancona, Italy.
  • Maestri M; Division of Clinical and Molecular Hepatology, University of Messina, Messina, Italy.
  • Gasbarrini A; Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy.
  • Jovine E; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy.
  • Grazi GL; Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
  • Rapaccini GL; Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Ruzzenente A; Alma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy.
  • Morisco F; Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.
  • Sacco R; Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Memeo R; Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
  • Crespi M; Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Napoli "Federico II," Napoli, Italy.
  • Antonucci A; Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy.
  • Bernasconi DP; Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy.
  • Romano F; Department of Surgery, L. Sacco Hospital, Milan, Italy.
  • Griseri G; Department of Surgery, Monza Policlinic, Monza, Italy.
  • Aldrighetti L; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy.
  • Torzilli G; School of Medicine and Surgery, University of Milan-Bicocca, Department of Surgery, San Gerardo Hospital, Monza, Italy.
  • Trevisani F; HPB Surgical Unit, San Paolo Hospital, Savona, Italy.
Ann Surg ; 275(4): 743-752, 2022 04 01.
Article in En | MEDLINE | ID: mdl-35081572
ABSTRACT

OBJECTIVE:

The aim of the study was to compare SURG vs SOR regarding the OS and progression-free survival (PFS) in a real-world clinical scenario. BACKGROUND DATA The treatment for advanced nonmetastatic HCC belonging to the Barcelona Clinic Liver Cancer stage C (BCLC C) is still controversial.

METHODS:

BCLC C patients without extrahepatic spread and tumoral invasion of the main portal trunk were considered. Surgical patients were obtained from the HE.RC.O.LE.S. Register, whereas sorafenib patients were obtained from the ITA.LI.CA register The inverse probability weighting (IPW) method was adopted to balance the confounders between the 2 groups.

RESULTS:

Between 2008 and 2019, 478 patients were enrolled 303 in SURG and 175 in SOR group. Eastern Cooperative Oncological Group Performance Status (ECOG-PS), presence of cirrhosis, steatosis, Child-Pugh grade, hepatitis B virus and hepatitis C virus, alcohol intake, collateral veins, bilobar disease, localization of the tumor thrombus, number of nodules, alpha-fetoprotein, age, and Charlson Comorbidity index were weighted by IPW to create two balanced pseudo-populations SURG = 374 and SOR = 263. After IPW, 1-3-5 years OS was 83.6%, 68.1%, 55.9% for SURG, and 42.3%, 17.8%, 12.8% for SOR (P < 0.001). Similar trends were observed after subgrouping patients by ECOG-PS = 0 and ECOG-PS >0, and by the intrahepatic location of portal vein invasion. At Cox regression, sorafenib treatment (hazard ratio 4.436; 95% confidence interval 3.19-6.15; P < 0.001) and Charlson Index (hazard ratio 1.162; 95% confidence interval 1.06-1.27; P = 0.010) were the only independent predictors of mortality. PFS at 1-3-5 years were 65.9%, 40.3%, 24.3% for SURG and 21.6%, 3.5%, 2.9% for SOR (P = 0.007).

CONCLUSIONS:

In BCLC C patients without extrahepatic spread but with intrahepatic portal invasion, liver resection, if feasible, was followed by better OS and PFS compared with sorafenib.
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Full text: 1 Database: MEDLINE Main subject: Carcinoma, Hepatocellular / Liver Neoplasms / Antineoplastic Agents Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Surg Year: 2022 Type: Article Affiliation country: Italy
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Full text: 1 Database: MEDLINE Main subject: Carcinoma, Hepatocellular / Liver Neoplasms / Antineoplastic Agents Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Surg Year: 2022 Type: Article Affiliation country: Italy