SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/10  
 
  2018 Oct;68(4):1232-1244.  
  doi: 10.1002/hep.30185.  
 
  Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study.  
 
  Vitale A, Farinati F, Noaro G, Burra P, Pawlik TM, Bucci L, Giannini EG, Faggiano C, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Virdone R, Marra F, Felder M, Morisco F, Benvegnù L, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Nardone G, Colecchia A, Fornari F, Marignani M, Vicari S, Bortolini E, Cozzolongo R, Grasso A, Aliberti C, Bernardi M, Frigo AC, Borzio M, Trevisani F, Cillo U; Italian Liver Cancer (ITA.LI.CA) group.  
  https://www.ncbi.nlm.nih.gov/pubmed/30048016  
 
 

Abstract

Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively).

CONCLUSION:

Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.

 

 
Question posée
 
Evaluer l’utilité pronostique de la réévaluation des patients avec carcinome hépatocellulaire (CHC) avant de modifier leur traitement à partir de 2 cohortes italiennes indépendantes et prospectives en comparant le score pronostique italien ITA.LI.CA et le score BCLC, le Hong Kong Liver Cancer et le Cancer of the Liver Italian Program systems.
 
Question posée
 
Le score ITA.LI.CA a la meilleure performance pronostique pour la réévaluation mais d’autres variables y sont associées : CHC progressif avant le 1er traitement, MELD à la réévaluation, traitement non chirurgical comme traitement additionnel.
 
Commentaires

Faut-il vraiment un autre score ?

 
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