ABSTRACT
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.
Subject(s)
Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/statistics & numerical data , Evidence-Based Medicine , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Aged , Carcinoma, Hepatocellular/pathology , Female , Humans , Italy/epidemiology , Kaplan-Meier Estimate , Liver Neoplasms/pathology , Male , Middle Aged , Patient Selection , Randomized Controlled Trials as Topic , Retrospective Studies , Survival Rate , Treatment OutcomeSubject(s)
Hepatitis C/therapy , Hepatitis, Chronic/therapy , Interferon-alpha/therapeutic use , Adolescent , Adult , Aged , Antibodies/blood , Female , Humans , Interferon Type I/immunology , Interferon Type I/therapeutic use , Interferon-alpha/administration & dosage , Male , Middle Aged , Neutralization Tests , Recombinant Proteins , Recurrence , Time FactorsABSTRACT
Of 282 consecutive ascites prospectively collected in 54 months, Spontaneous Bacterial Peritonitis (SBP) was diagnosed in 8.5% of the cases, "probable" SBP in 31.1%, Bacteriascites (BA) in 3.5% and Sterile Ascites (SA) (negative ascitic fluid culture with PMN less than 250/mm3) in 74.8%. Escherichia Coli (41.6%) and Staphylococcus Epidermidis (60%) were the most frequent pathogens isolated in patients with SBP and BA, respectively. With regards to in-hospital mortality, 18% of patients with BA and 50% with SBP died; the mortality seemed to be related to the degree of hepatic and renal damage, to a higher peripheral and ascitic WBC concentration and to a lower pH of ascitic fluid (FA). When the comparative analysis was applied to the four groups of ascites, a different distribution of clinical signs and biohumoral parameters appeared. As a matter of fact, abdominal pain, fever and rebound tenderness resulted significantly more frequent in SBP and "probable" SBP. Furthermore, the mean values of peripheral and ascitic WBC concentration, of serum creatinine and of ALT were statistically higher in SBP and "probable" SBP than in SA and BA groups. The strict relationship, both symptomatologic and biochemical, between SA and BA on the one hand and between "probable" SBP and SBP on the other, prompted us to conclude that "probable" SBP and SBP represent different patterns of the same disease. Therefore, the subclassification in the four groups outlined above would not be in accordance with the clinical practice and could give rise to the physician's confusion and uncertainty.
