Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage

Abstract

OBJECTIVES:This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease.METHODS:This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test.RESULTS:The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09–0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67–9.88; p<0.001), whereas no differences were observed in patients in stages B or C.CONCLUSIONS:The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.

Impact of direct-acting antiviral therapy for hepatitis C–related hepatocellular carcinoma

“…To consider the risk of liver failure and tumor burden in the terminal stage of HCC, DAA was not prescribed in our general practice; therefore, this stage was excluded. A previous study revealed that the OS in stage D patients was worse in patients adherent to HCC therapy than in nonadherent patients [29]. AASLD guidance recommends that patients with a life expectancy of less than 12 months are unlikely to benefit from HCV eradication and therefore palliative care is suggested [30].…”

Brazilian Society of Hepatology Updated Recommendations for Diagnosis and Treatment of Hepatocellular Carcinoma

“…In this regard, the Barcelona Clinic Liver Cancer (BCLC) classification accomplishes these goals (105) . This system has been extensively used worldwide (106) and in Brazil (1,107) . Importantly, several other classifications are mentioned in American, European, and Asian literature such as TNM, Cancer of the Liver Italian Program (CLIP), Hong Kong Liver Cancer (HKCL), and Japanese Integrated Staging (JIS) score (108)(109)(110)(111) .…”

Osteopontin promotes hepatocellular carcinoma progression via the PI3K/AKT/Twist signaling pathway

“…To determine the prognostic value of Twist for HCC patients, univariate and multivariate analyses were performed on the clinicopathological characteristics and Twist expression levels of patients (Table II). Univariate analysis revealed that OPN expression, Twist expression, serum AFP level, hepatitis B surface antigen, tumor size, tumor capsulation, vascular invasion, Barcelona Clinic Liver Cancer stage (41) and tumor differentiation were significantly associated with the OS and TTR times of patients with HCC (Table II). However, no prognostic significance for OS or TTR was observed in association with the other characteristics, including sex, age, liver cirrhosis, ALT and tumor number.…”