Heterogeneity of Patients with Intermediate (BCLC B) Hepatocellular Carcinoma: Proposal for a Subclassification to Facilitate Treatment Decisions

Luigi Bolondi; Andrew Burroughs; Jean-François Dufour; Peter R. Galle; Vincenzo Mazzaferro; Fabio Piscaglia; Jean Luc Raoul; Bruno Sangro

doi:10.1055/s-0032-1329906

Seminars in Liver Disease, Inhaltsverzeichnis

Semin Liver Dis 2012; 32(04): 348-359
DOI: 10.1055/s-0032-1329906

Editors' Choice

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Heterogeneity of Patients with Intermediate (BCLC B) Hepatocellular Carcinoma: Proposal for a Subclassification to Facilitate Treatment Decisions

Authors

Luigi Bolondi

¹Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
Andrew Burroughs

²The Royal Free Sheila Sherlock Liver Centre, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, UCL London, London, UK
Jean-François Dufour

³University Clinic for Visceral Surgery and Medicine, Inselspital, Bern and Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
Peter R. Galle

⁴University Medical Center, I. Medical Department, Johannes Gutenberg University, Mainz, Germany
Vincenzo Mazzaferro

⁵Istituto Nazionale Tumori (National Cancer Institute) IRCCS Foundation, Milan, Italy
Fabio Piscaglia

¹Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
Jean Luc Raoul

⁶Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
Bruno Sangro

⁷Liver Unit, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Pamplona, Spain

Abstract

The intermediate stage of hepatocellular carcinoma (HCC) comprises a highly heterogeneous patient population and therefore poses unique challenges for therapeutic management, different from the early and advanced stages. Patients classified as having intermediate HCC by the Barcelona Clinic Liver Cancer (BCLC) staging system present with varying tumor burden and liver function. Transarterial chemoembolization (TACE) is currently recommended as the standard of care in this setting, but there is considerable variation in the clinical benefit patients derive from this treatment.

In April 2012, a panel of experts convened to discuss unresolved issues surrounding the application of current guidelines when managing patients with intermediate HCC. The meeting explored the applicability of a subclassification system for intermediate HCC patients to tailor therapeutic interventions based on the evidence available to date and expert opinion. The present report summarizes the proposal of the expert panel: four substages of intermediate HCC patients, B1 to B4.

Keywords

hepatocellular carcinoma - sorafenib - transarterial chemoembolization - radioembolization - Barcelona Clinic Liver Cancer

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Referenzen

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