Impact of evidence-based medicine on treatment of patients with unresectable hepatocellular carcinoma. Giannini EG, Bodini G, Corbo M, Savarino V, Risso D, DI Nolfo MA, Del Poggio P, Benvegnù L, Farinati F, Zoli M, Borzio F, Caturelli E, Chiaramonte M, Trevisani F; FOR THE ITALIAN LIVER CANCER (ITA.LI.CA.) GROUP. Aliment Pharmacol Ther. 2009 Nov 14. [Epub ahead of print] Abstract Background: A randomised 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). Our study aimed at assessing whether this information has modified the use of TACE in clinical practice. Methods: From 2,042 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, patients characteristics, and survival. Results: Patients undergoing TACE increased in the 2003-2006 period (62% to 73%, p=0.035), with an increase in of Child-Pugh class A (64% to 77%, p=0.048) and advanced HCC patients (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.