Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Reverse time-dependent effect of alphafetoprotein and disease control on survival of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma
Francesca Romana Ponziani, Irene Spinelli, Emanuele Rinninella, Lucia Cerrito, Antonio Saviano, Alfonso Wolfango Avolio, Michele Basso, Luca Miele, Laura Riccardi, Maria Assunta Zocco, Brigida Eleonora Annicchiarico, Matteo Garcovich, Marco Biolato, Giuseppe Marrone, Anna Maria De Gaetano, Roberto Iezzi, Felice Giuliante, Fabio Maria Vecchio, Salvatore Agnes, Giovanni Addolorato, Massimo Siciliano, Gian Lodovico Rapaccini, Antonio Grieco, Antonio Gasbarrini, Maurizio Pompili
Francesca Romana Ponziani, Irene Spinelli, Emanuele Rinninella, Lucia Cerrito, Antonio Saviano, Luca Miele, Laura Riccardi, Maria Assunta Zocco, Brigida Eleonora Annicchiarico, Matteo Garcovich, Marco Biolato, Giuseppe Marrone, Giovanni Addolorato, Massimo Siciliano, Gian Lodovico Rapaccini, Antonio Grieco, Antonio Gasbarrini, Maurizio Pompili, Department of Internal Medicine, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Rome 00168, Italy
Alfonso Wolfango Avolio, Salvatore Agnes, Department of Liver Transplant Surgery, Agostino Gemelli Hospital, Rome 00168, Italy
Michele Basso, Department of Oncology, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Rome 00168, Italy
Anna Maria De Gaetano, Roberto Iezzi, Department of Bioimaging and Radiological Sciences, Agostino Gemelli Hospital, Rome 00168, Italy
Felice Giuliante, Department of Hepatobiliary Surgery, Agostino Gemelli Hospital, Rome 00168, Italy
Fabio Maria Vecchio, Department of Pathology, Agostino Gemelli Hospital, Rome 00168, Italy
Author contributions: Ponziani FR designed and performed the research, collected data, wrote the paper, performed statistical analysis, revised and approved the final version of the paper; Spinelli I collected data, wrote the paper, revised and approved the final version of the paper; Pompili M, Avolio AW, Siciliano M, Basso M and Miele L contributed to statistical analysis, wrote the paper, revised and approved the final version of the paper; Rinninella E, Cerrito L, Saviano A, Riccardi L, Zocco MA, Annicchiarico BE, Garcovich M, Biolato M, Marrone G, De Gaetano AM, Iezzi R, Giuliante F, Vecchio FM, Agnes S, Addolorato G, Rapaccini GL, Grieco A and Gasbarrini A contributed to this paper.
Institutional review board statement: This is a retrospective study based on the revision of anonymous clinical data; no additional interventional procedures or drug was performed/administered to the study population. Therefore, no institutional review board approval was required.
Informed consent statement: This is a retrospective study based on the revision of anonymous clinical data; no additional interventional procedures or drug was performed/administered to the study population. Therefore, no informed consent was obtained by the patients.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Francesca Romana Ponziani, MD, Department of Internal Medicine, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Largo Agostino Gemelli 8, Rome 00168, Italy. francesca.ponziani@yahoo.it
Telephone: +39-34-71227242
Received: August 27, 2017
Peer-review started: August 30, 2017
First decision: September 21, 2017
Revised: October 12, 2017
Accepted: November 11, 2017
Article in press: November 12, 2017
Published online: December 28, 2017
ARTICLE HIGHLIGHTS
Research background
Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) includes a heterogeneous group of patients with different clinical and tumor characteristics and survival expectancy, for whom sorafenib is the only recommended treatment option. The present study investigates the outcome of BCLC C patients who underwent different locoregional, surgical or systemic treatments.
Research motivation
To better stratify the prognosis of patients with BCLC C stage HCC.
Research objectives
To characterize the prognosis of cirrhotic patients with BCLC stage C HCC as assessed by a multidisciplinary team in an Italian tertiary care center and to identify those factors predicting the achievement of disease control (DC).
Research methods
The prospective database of the Hepatocatt multidisciplinary group, containing clinical, tumor and outcome data of all liver cancer subjects evaluated in the seven years at our Institute was reviewed.
Research results
The study confirms that the BCLC stage C comprises a huge heterogeneous group of cirrhotic patients suitable for locoregional and potentially curative treatments. Moreover, this is the first report highlighting the reverse and time-dependent effect of alphafetoprotein (AFP) serum level and DC as prognostic factors in cirrhotic patients with advanced stage HCC.
Research conclusions
The novel finding surfaced out from our study is the dynamic influence of AFP serum level and DC on survival period. In particular, the AFP serum level > 200 ng/mL was significantly associated with higher risk of mortality within the first 6 mo of patients’ entry into the BCLC stage C; conversely, DC exercised a significant protective effect in long-term phase. Our report also highlight that the presence of macrovascular invasion and/or extrahepatic spread is independently associated with a reduced likelihood of achieving DC. Based on these findings, curative and locoregional treatments should not be “a priori” excluded in a subset of BCLC stage C patients. Indeed, predictive factors may be helpful in the sophistication of patients’ prognosis, thereby being valuable in the selection of patients suitable for clinical trials and in designing the therapeutic strategy.
Research perspectives
Given the higher number of heterogeneous and complex cases encountered in the field-practice, the BCLC classification is often not exhaustive, and the increasing number of new therapeutic options and their combinations makes difficult to strictly adhere to BCLC suggestions. New algorithms for the stratification of patients’ prognosis are needed to improve clinical practice.
