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Virginia Erroi

Other affiliations: University of Genoa
Bio: Virginia Erroi is an academic researcher from University of Bologna. The author has contributed to research in topics: Liver cancer & Hepatocellular carcinoma. The author has an hindex of 8, co-authored 9 publications receiving 357 citations. Previous affiliations of Virginia Erroi include University of Genoa.

Papers
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Journal ArticleDOI
TL;DR: A single‐centre retrospective study compares the outcomes achieved with sorafenib and TARE in HCC patients potentially amenable to either therapy.
Abstract: Background & Aims: Sorafenib and transarterial 90 Y-radioembolization(TARE) are possible treatments for Barcelona Clinic Liver Cancer (BCLC)intermediate-advanced stage hepatocellular carcinoma (HCC). No studydirectly comparing sorafenib and TARE is currently available. This single-centre retrospective study compares the outcomes achieved with sorafeniband TARE in HCC patients potentially amenable to either therapy. Meth-ods: Seventy-four sorafenib (71 ± 10 years, male 87%, BCLC B/C 53%/47%)and 63 TARE HCC patients (66 ± 9 years, male 79%, BCLC B/C 41%/59%)were included based on the following criteria: Child–Pugh class A/B, perfor-mance status ≤1, HCC unfit for other effective therapies, no metastases andno previous systemic chemotherapy. Results: Median overall survivals of thetwo groups were comparable, being 14.4 months (95% CI: 4.3–24.5) in so-rafenib and 13.2 months (95% CI: 6.1–20.2) in TARE patients, with 1-, 2-and 3-year survival rates of 52.1%, 29.3% and 14.7% vs 51.8%, 27.8% and21.6% respectively. Two TARE patients underwent liver transplantation aftersuccessful down-staging. To minimize the impact of confounding factors onsurvival analysis, propensity model matched 32 patients of each group formedian age, tumour gross pathology and the independent prognostic factors(portal vein thrombosis, performance status, Model for End Liver Disease).Even after matching, the median survival did not differ between sorafenib(13.1 months; 95% CI: 1.2–25.9) and TARE patients (11.2 months; 95% CI:6.7–15.7), with comparable 1-, 2- and 3-year survival rates. Conclusions: Incirrhotic patients with intermediate-advanced or not-otherwise-treatableHCC, sorafenib and TARE provide similar survivals. Down-staging allowingliver transplantation only occurred after TARE.Hepatocellular carcinoma (HCC) is the third most com-mon cause of cancer-related death worldwide, and theleading cause of mortality of cirrhotic patients (1, 2).Several curative or palliative treatments are currentlyavailable, according to the cancer burden and liver func-tion. For this choice, American and European guidelinessuggest the use of the Barcelona Clinic Liver Cancer(BCLC) classification which links tumour stage to treat-ment in an evidence-based fashion (3, 4). Only 30–40%of HCCs are diagnosed at an early stage, and advancedstage HCCs (BCLC stage C) account for a large propor-tion of the remaining cases (5). Moreover, despite treat-ment, most early HCCs eventually progress to theadvanced stage. The recommended treatment for thesetumours is sorafenib, because two phase III clinical trialsproved that this treatment prolongs the survival ofChild–Pugh A patients with advanced HCC (6, 7).However, the tolerability of sorafenib is suboptimal, andin a post-marketing multicentre study, it was down-dosed in more than half of the patients and interruptedin 45% of cases, because of severe adverse effects (AEs)or liver function deterioration (8).As more than two-thirds of patients with advancedHCC die from intrahepatic tumour progression or liverfailure, rather than from metastatic disease (9–12), aneffective and well-tolerated locoregional treatment could

102 citations

Journal ArticleDOI
TL;DR: Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC.
Abstract: Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.

76 citations

Journal ArticleDOI
TL;DR: This work aimed to test the hypothesis that stressful conditions could further prolong QT interval prolongation and, if it proved correct, to assess its prognostic meaning.
Abstract: Background & aims QT interval prolongation is frequent in cirrhosis, and stressful conditions could further prolong QT. We aimed to test this hypothesis and, if it proved correct, to assess its prognostic meaning. Methods We reviewed the clinical records of 70 consecutive cirrhotic and 40 non-cirrhotic patients with acute gastrointestinal bleeding. All patients had been evaluated before bleeding (T0) and were re-evaluated at the time of bleeding (T1) and 6 weeks afterwards (T2). Results QT corrected by heart rate (QTc) lengthened at T1, returning towards baseline values at T2 (mean ± SEM; from 415.9 ± 4.3 to 453.4 ± 4.3 to 422.2 ± 5.7 ms, P < 0.001) in cirrhotics; contrariwise, QTc did not change in non-cirrhotic patients. The 6-week mortality was 29.6% among cirrhotic patients, while no control patient died. At T1, patients who died had longer QTc (P = 0.001) and higher model of end-stage liver disease (MELD) score (P < 0.001) than survivors. MELD and QTc independently predicted survival. Their areas under the ROC curve were 0.88 (CI 95% 0.78–0.95) and 0.75 (CI 95% 0.63–0.85) respectively; the best cut-off values were MELD ≥20 and QTc ≥ 460 ms. Based on these factors, the 6-week mortality was: 0% for patients without risk factors, 32.1% for those with one risk factor and 70.6% for those with both (P < 0.001). Conclusions Acute gastrointestinal bleeding further prolongs QTc in cirrhosis. This abnormality independently predicts bleeding-induced mortality. The combined measurement of QTc interval and MELD can clearly identify three patient strata at increasing risk of bleeding-related mortality, thus improving the decision-making for these patients.

45 citations

Journal ArticleDOI
TL;DR: Economic aspects of HCC surveillance are analyzed to verify the cost-effectiveness of surveillance, its optimal periodicity, the target population and the role of alternative surveillance strategies.
Abstract: Screening for primary liver cancer means surveillance for hepatocellular carcinoma (HCC), which is one of the most common cancers worldwide. Detection of HCC for curative treatment is increased by surveillance, but target population, optimal periodicity and cost-effectiveness aspects are still debated issues. The aim of surveillance is to obtain a reduction in HCC-related mortality and this is usually achieved through an early diagnosis that increases both applicability and cost-effectiveness of curative treatments. The aim of the present review is to analyse economic aspects of HCC surveillance. Articles that assessed cost-effectiveness of surveillance for HCC, published between 1996 and February 2013, were reviewed in order to verify the cost-effectiveness of surveillance, its optimal periodicity, the target population and the role of alternative surveillance strategies. International guidelines are currently based on the results of such cost-effectiveness analyses, highlighting the importance of the release of cost-effectiveness-guided guidelines for HCC management.

36 citations


Cited by
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Journal ArticleDOI
TL;DR: The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.

7,851 citations

Journal ArticleDOI
TL;DR: This paper aims to demonstrate the efforts towards in-situ applicability of EMMARM, as to provide real-time information about concrete mechanical properties such as E-modulus and compressive strength.

2,416 citations

Journal ArticleDOI
TL;DR: The panel of experts, having emphasised the importance of initiating aetiologic treatment for any degree of hepatic disease at the earliest possible stage, extended its work to all the complications of cirrhosis which had not been covered by the European Association for the Study of the Liver guidelines.

1,534 citations

Journal ArticleDOI
TL;DR: Studies now aim to identify molecular markers and imaging techniques that can detect patients with HCC at earlier stages and better predict their survival time and response to treatment.

1,260 citations