The impact of BCLC recommendations on survival for patients with hepatocellular carcinoma.

IF 5.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Communications Pub Date : 2025-07-14 eCollection Date: 2025-08-01 DOI:10.1097/HC9.0000000000000750

Massimo Iavarone, Eleonora Alimenti, Lorenzo Canova, Mariangela Bruccoleri, Barbara Antonelli, Anna Maria Ierardi, Angelo Sangiovanni, Giuseppe Cabibbo, Annalisa De Silvestri, Lucio Caccamo, Gianpaolo Carrafiello, Pietro Lampertico

{"title":"The impact of BCLC recommendations on survival for patients with hepatocellular carcinoma.","authors":"Massimo Iavarone, Eleonora Alimenti, Lorenzo Canova, Mariangela Bruccoleri, Barbara Antonelli, Anna Maria Ierardi, Angelo Sangiovanni, Giuseppe Cabibbo, Annalisa De Silvestri, Lucio Caccamo, Gianpaolo Carrafiello, Pietro Lampertico","doi":"10.1097/HC9.0000000000000750","DOIUrl":null,"url":null,"abstract":"Background: The Barcelona Clinic Liver Cancer (BCLC) system for HCC was updated in 2022. The aim of the study was to assess the suitability and impact on overall survival (OS) of BCLC_2022, along with \"clinical decision-making\" (CDM), using BCLC_2018 as a benchmark.Methods: We retrospectively evaluated 798 patients with de novo HCC followed prospectively from 2006 to 2022: 187 in BCLC 0, 371 in A, 132 in B, 87 in C, and 21 in D, all managed by a multidisciplinary team. Patients were followed until death or at the end of the follow-up period in December 2022.Results: The suitability of the algorithm increased from 51% for BCLC_2018 to 69% for BCLC_2022 (p<0.001). Among those treated with the newly introduced \"lower priority options,\" 22% were in BCLC 0 and 37% in A, showing lower rates of complete response (CR) and shorter OS compared to first-line treatments. In BCLC 0 and A, CDM was associated with a significant decrease in \"downward stage migration\" with BCLC_2022 (from 33% to 16%, p<0.001). Conversely, in BCLC B and C, \"upward stage migration\" correlated with higher CR rates and longer OS [63 (36-72) vs. 28 (18-44) months, p=0.003 in BCLC B; 21 (15-44) vs. 11 (4-25) months, p<0.001 in BCLC C]. Independent predictors of mortality included AFP >200 ng/mL, Child-Pugh score C, advanced BCLC stage, and noncurative treatment.Conclusions: BCLC_2022 and CDM provide greater flexibility in clinical practice without adversely affecting patient survival. Access to curative treatments improves the outcomes of selected patients in all stages.","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"9 8","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263035/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatology Communications","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HC9.0000000000000750","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The Barcelona Clinic Liver Cancer (BCLC) system for HCC was updated in 2022. The aim of the study was to assess the suitability and impact on overall survival (OS) of BCLC_2022, along with "clinical decision-making" (CDM), using BCLC_2018 as a benchmark.

Methods: We retrospectively evaluated 798 patients with de novo HCC followed prospectively from 2006 to 2022: 187 in BCLC 0, 371 in A, 132 in B, 87 in C, and 21 in D, all managed by a multidisciplinary team. Patients were followed until death or at the end of the follow-up period in December 2022.

Results: The suitability of the algorithm increased from 51% for BCLC_2018 to 69% for BCLC_2022 (p<0.001). Among those treated with the newly introduced "lower priority options," 22% were in BCLC 0 and 37% in A, showing lower rates of complete response (CR) and shorter OS compared to first-line treatments. In BCLC 0 and A, CDM was associated with a significant decrease in "downward stage migration" with BCLC_2022 (from 33% to 16%, p<0.001). Conversely, in BCLC B and C, "upward stage migration" correlated with higher CR rates and longer OS [63 (36-72) vs. 28 (18-44) months, p=0.003 in BCLC B; 21 (15-44) vs. 11 (4-25) months, p<0.001 in BCLC C]. Independent predictors of mortality included AFP >200 ng/mL, Child-Pugh score C, advanced BCLC stage, and noncurative treatment.

Conclusions: BCLC_2022 and CDM provide greater flexibility in clinical practice without adversely affecting patient survival. Access to curative treatments improves the outcomes of selected patients in all stages.

Abstract Image

查看原文本刊更多论文

BCLC推荐对肝细胞癌患者生存的影响

背景：巴塞罗那临床肝癌（BCLC）系统于2022年更新。该研究的目的是评估BCLC_2022的适用性及其对总生存期（OS）的影响，以及以BCLC_2018为基准的“临床决策”（CDM）。方法：我们回顾性评估了2006年至2022年798例新发HCC患者的前瞻性随访：187例BCLC 0, 371例A， 132例B， 87例C， 21例D，所有患者均由一个多学科团队管理。患者被跟踪到死亡或在2022年12月随访期结束。结果：该算法的适用性从BCLC_2018的51%增加到BCLC_2022 (p200 ng/mL， Child-Pugh评分C，晚期BCLC分期，无治愈治疗的69%。结论：BCLC_2022和CDM在临床实践中提供了更大的灵活性，而不会对患者的生存产生不利影响。获得治愈性治疗可改善各阶段选定患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

8.00

自引率

2.00%

发文量

248

审稿时长

8 weeks

期刊介绍： Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction.