亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        BCLC staging system and liver transplantation: From a stage to a therapeutic hierarchy

        2021-11-26 04:32:35QuirinoLiAlessndroVitle

        Quirino Li , , Alessndro Vitle

        a Hepato-biliary and Organ Transplant Unit, Department of Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy

        b Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

        The Barcelona Clinic Liver Cancer (BCLC) system was proposed in 1999 with the intent to improve a therapeutic algorithm for the management of patients with hepatocellular carcinoma (HCC) [1].Both the European and the American Guidelines on the Treatment of HCC have endorsed the BCLC as the standard staging algorithm with prognostic and therapeutic implications [ 2 , 3 ].

        The BCLC staging system stratifies HCC patients into five stages(0, A, B, C and D). According to the algorithm, liver transplantation(LT) is indicated only in patients in the stages BCLC 0 and A, special situations provided.

        However, some doubts have been risen on the real possibility to maintain a strict adherence of this standard system in the real clinical practice, mainly in the case of intermediate and advanced patients [4]. In the specific setting of LT, a large study based on the ITA.LI.CA database showed a survival benefit for patients with intermediate tumors (BCLC stages B-C) and advanced liver cirrhosis(BCLC stage D), regardless of the nodule number-size criteria, provided that macroscopic vascular invasion and extra-hepatic disease are absent [5].

        A recent study from Mainz further investigated this aspect [6].In the study, Otto et al. analyzed the data of 198 HCC patients who underwent LT. As for the BCLC classification, the staging was as follows: 0 = 5; A = 77; B = 41; C = 53; and D = 22. According to these results, LT was performed in 116/198 (58.6%) patients against BCLC recommendations. Moreover, surgery (n= 16), radiofrequency ablation (n= 15) and transarterial chemoembolization (n= 151) preceded LT in 182 (91.9%) patients. Also in this case, the everyday management of a patient waiting for LT did not follow the algorithm.

        Interestingly, the BCLC classification did neither impact survival(P= 0.796) nor recurrence (P= 0.693). Lastly, at multivariable Cox regression analysis, the BCLC algorithm was not an independent risk factor for the outcome, while the lack of response to pretreatment and initial alpha-fetoprotein values were.

        According to the observed results, the principal limitations of the BCLC look to be in their lack of flexibility and disregard of biological parameters into the model.

        Recently, new scoring systems have been proposed with the intent to overpass these limits. The Hong Kong Liver Cancer classification was developed based on the analysis of 3856 patients,showing a significantly better ability than the BCLC system to distinguish between patients with specific overall survival time[area under the curve (AUC) = 0.84 vs. 0.80]. More importantly, the Hong Kong criteria identified subsets of BCLC intermediate- and advanced-stage patients to be able to obtain improved survival outcomes when they were treated with more aggressive therapies comprehending LT [7].

        The ITA.LI.CA prognostic score based on 1196 (training cohort)and 648 (validation cohort) HCC patients showed a superior predictive performance after restaging the patients after any treatment, with an AUC = 0.745 in the validation cohort [8].

        Recently the new concept of "therapeutic hierarchy" has been proposed instead of the “stage hierarchy" of the BCLC system, with the attempt to increase the flexibility of the decision-making [9].In other terms, the treatment decision is hierarchically dictated by the efficacy of each therapy, with complete or partial independence from the tumor stage.

        In conclusion, the paradigm of “stage hierarchy” looksto betoo old for the routine clinical management of LT patients. A shift of this paradigm is on the way.

        Acknowledgments

        None.

        Credit authorship contribution statement

        Quirino Lai :Conceptualization, Data curation, Investigation,Writing - original draft, Writing –review & editing.Alessandro Vitale:Supervision, Data curation, Investigation, Writing - original draft.

        Funding

        None.

        Ethical approval

        Not needed.

        Competing interest

        No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

        亚洲av高清一区二区| 亚洲欧美国产精品久久久| 国产精品白浆视频免费观看| 精品亚洲一区二区99| av男人操美女一区二区三区| 久久国产精品亚洲我射av大全| 丰满少妇人妻无码| 国产内射一级一片高清内射视频| 日本一区二区三区视频免费观看| 国产亚洲精品久久久久5区| 少妇愉情理伦片| 日韩欧群交p片内射中文| 精品国产v无码大片在线观看| 香蕉视频一级| 99福利影院| 蜜桃视频网站在线免费观看| 少妇被粗大的猛进69视频| 日本大肚子孕妇交xxx| 欧洲女人性开放免费网站| 无码夜色一区二区三区| 国产欧美日韩综合一区二区三区| 国内精品91久久久久| 亚洲综合视频一区二区| 无码av天天av天天爽| 亚洲av午夜国产精品无码中文字| av片在线观看免费| 中文字幕经典一区| 人妻爽综合网| 网址视频在线成人亚洲| 国产情侣自拍在线视频| 麻豆蜜桃av蜜臀av色欲av| 人妻有码中文字幕| 内射后入在线观看一区| 成人国产永久福利看片| 国产精品毛片av一区二区三区| 国产情侣亚洲自拍第一页| 亚洲性色av一区二区三区| 国产顶级熟妇高潮xxxxx| 国产成人无码aⅴ片在线观看| 婷婷五月亚洲综合图区| 91精品啪在线观看国产色|