Impact of evidence‐based medicine on the treatment of patients with unresectable hepatocellular carcinoma |
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| Authors: | E G GIANNINI G BODINI M CORBO V SAVARINO D RISSO M A DI NOLFO P DEL POGGIO L BENVEGNù F FARINATI M ZOLI F BORZIO E CATURELLI M CHIARAMONTE F TREVISANI FOR THE ITALIAN LIVER CANCER GROUP |
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| Institution: | 1. Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy;2. Cattedra di Statistica Medica, Dipartimento di Scienze della Salute, Università di Genova, Genova, Italy;3. Divisione di Medicina, Ospedale Bolognini, Seriate, Italy;4. Divisione di Medicina, Ospedale Treviglio‐Caravaggio, Treviglio, Italy;5. Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy;6. Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy;7. Dipartimento di Medicina Clinica, Alma Mater Studiorum‐Università di Bologna, Bologna, Italy;8. Dipartimento di Medicina, Unità di Gastroenterologia, Ospedale Fatebenefratelli, Milano, Italy;9. Unità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy |
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| Abstract: | Aliment Pharmacol Ther 31 , 493–501 Summary Background A randomized controlled trial performed by the Barcelona Clinic Liver Cancer (BCLC) published in 2002 demonstrated that transcatheter arterial chemoembolisation (TACE) is an effective treatment for well‐selected patients with unresectable hepatocellular carcinoma (HCC). Aim To access whether this information has modified the use of TACE in clinical practice. Methods From 2042 HCC patients included in the Italian Liver Cancer database, we selected 336 cases diagnosed over two 4‐year periods (1999–2002, n = 161 and 2003–2006, n = 175), fulfilling the inclusion criteria of the BCLC study. These groups were compared for TACE application rate, patient characteristics and survival. Results Patients undergoing TACE increased in the 2003–2006 period (from 62% to 73%, P = 0.035), with an increase in of Child‐Pugh class A (from 64% to 77%, P = 0.048) and advanced HCC patients (from 54% to 69%, P = 0.041). In the 1999–2002 period, there was no significant difference in survival between TACE‐treated and untreated patients, while in the 2003–2006 period, TACE‐treated patients survived longer (P < 0.0001). Conclusions Following the publication of studies providing evidence of a survival benefit of TACE in selected patients with unresectable HCC, significantly more patients with well‐compensated cirrhosis underwent TACE within this very homogenous population, leading to an increased survival despite a more advanced tumour stage. |
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