1015 THE CHALLENGE OF TREATING HCC IN CHILD-PUGH B: NEED FOR SUBCLASSIFICATION

Abstract

Background and Aims: Treatment of HCC in cirrhosis should provide effective antitumoral treatment and concurrently preserve liver function. According to EASL and AASLD guidelines HCCCPTB patients should be submitted to treatment following tumor extent categorized with Barcelona classification. However, the decision has to be individualized in order to avoid overtreatment and precipitating liver failure. Aim of the present study was to investigate treatment allocation in Child–Pugh B HCC patients subgrouped according to BCLC and Child–Pugh, to determine whether within the B class significant differences exist in eligibility to treatments. Methods: Among all consecutive patients with first diagnosis of HCC referred to our Centre between March 2001 and December 2007, we retrospectively identified and evaluated for treatment Child–Pugh B patients. Treatment was decided following individual assessment of tumor burden, BCLC stage, liver function, technical requirements, potential risks for tumor treatment and expected impact on liver function. Results: A total of 86 patients were observed: 42 were scored as Child–Pugh B7, 28 as B8 and 16 as B9. Staging was BCLC-A4 in 45 patients (47%, 33% and 20% in B7, B8 and B9 respectively), BCLC-B in 27 (59%, 37% and 4% respectively), BCLC-C in 12 (42%, 25% and 33% respectively) and BCLC-D in 2 (100% Child–Pugh B8). Patients with early HCC (BCLC-A4) could almost always be offered curative treatments if B7 (95%) and often if B8 (73%) or B9 (78%), with very few patients (respectively 0%, 7% and 11%) allocated to only best supportive care (BSC). The rate of patients who were not offered effective treatments was significantly higher in intermediate patients with increasing Child–Pugh score (BCLC-B) with 37.5% in B7, 50% in B8, 1 of 1=100% in B9. Similarly the rate of advanced patients (12 BCLC-C/D) who were allocated to BSC was 20% in B7, 67% in B8 and 83% in B9. Discussion: The Child–Pugh B class is very heterogeneous and significant differences were found in the possibility to allocate patients to different treatments according to the progression of hepatic dysfunction from CPT-B7 to B9. A subclassification of patients in Child–Pugh B appears warranted to the aim of their treatment allocation.