Adherence to Barcelona Clinic Liver Cancer guidelines in field practice: Results of Progetto Epatocarcinoma Campania

Guarino, Maria; Tortora, Raffaella; Stefano, G. de; Coppola, Carmine; Morisco, Filomena; Megna, Angelo Salomone; Izzo, Francesco; Nardone, Gerardo; Piai, G.; Adinolfi, Luigi Elio; D’Adamo, Giuseppe; Gaeta, Giovanni Battista; Messina, Vito; Francica, Giampiero; Girolamo, V. De; Coppola, Nicola; Persico, Marcello; Costanzo, Giovan Giuseppe Di

doi:10.1111/jgh.14013

Cited by 20 publications

(10 citation statements)

References 29 publications

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“…Previous studies from Italy [13,14] reported that non-adherence to the original BCLC guidelines [5] was common in real-world practice. Our primary aim in this study, relatedly, was to evaluate adherence to the modified BCLC guidelines and its impact on patient survival in a high-volume liver surgery center in East Asia, where there are higher etiological prevalence rates of hepatitis B virus (HBV) (including HBV-associated non-cirrhotic HCC) and lower prevalence rates of hepatitis C virus (HCV) and non-alcoholic fatty liver disease (NAFLD) than in Western countries [7].…”

Section: Introductionmentioning

confidence: 99%

Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

et al. 2021

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Background and aims The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely applied staging system for hepatocellular carcinoma (HCC) and is recommended for treatment allocation and prognostic prediction. The BCLC guidelines were modified in 2018 to indicate that Child-Pugh A without any ascites is essential for all stages except stage D. This study sought to provide a description of patients with HCC treated at a high-volume liver surgery center in Taiwan where referral is not needed and all treatment modalities are available and reimbursed by the National Health Insurance program. As such, certain variables that could modulate treatment decisions in clinical practice, including financial constraints, the availability of treatment procedures, and the expertise of the hospital, could be excluded. The study further sought to evaluate the adherence to the modified BCLC guidelines. Methods This was a retrospective study with prospectively collected data. 1801 consecutive patients with de novo HCC were enrolled through our institution from 2011–2017. Results There were 302 patients with stage 0, 783 with stage A, 242 with stage B, 358 with stage C, and 116 with stage D HCC. Treatment adhering to the modified BCLC guidelines recommendations was provided to 259 (85.8%) stage 0 patients, 606 (77.4%) stage A patients, 120 (49.6%) stage B patients, 93 (26.0%) stage C patients, and 83 (71.6%) stage D patients. Conclusions We reported treatment adhering to the modified BCLC guidelines at a high-volume liver surgery center in Taiwan. We found that non-adherence to the modified BCLC staging system was common in treating stage B and C patients.

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Section: Introductionmentioning

confidence: 99%

Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

et al. 2021

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“…Nonadherence to the original BCLC guidelines [ 29 , 30 ] is common in real-world practice. In this regard, a subset of BCLC intermediate and advanced-stage patients underwent a more aggressive treatment than what were recommended by the BCLC system.…”

Section: Discussionmentioning

confidence: 99%

Levels of Alpha-Fetoprotein and Association with Mortality in Hepatocellular Carcinoma of HIV-1-Infected Patients

Morsica¹,

Galli²,

Messina³

et al. 2022

Journal of Oncology

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Background and Aim. The clinical course of hepatocellular carcinoma (HCC) is determined by cancer-related and nonrelated factors. We evaluated the effect of a cancer-related factor, alpha-fetoprotein (AFP) levels, on mortality in HIV-1-infected patients with HCC. Methods. This is a retrospective cohort study on patients living with HIV-1 infection (PLWH) followed at the Division of Infectious Diseases of the San Raffaele Hospital, with cirrhosis and HCC diagnosed between 1999 and 2018 and with an available AFP value at HCC diagnosis. The area under the receiver operating characteristic curve (AUC) was used to estimate the accuracy of baseline AFP in predicting death. Factors associated with the risk of death were identified using multivariable Cox proportional-hazards regression models. Results. Overall, 53 PLWH were evaluated: 18 patients received a curative treatment (9 liver transplantation, 5 liver resections and 4 radiofrequency ablation) and 35 a noncurative treatment (17 chemo or radio embolization, 10 sorafenib and 8 best supportive care). Baseline AFP was predictive of death [AUC 0.71, 95% confidence interval (CI) 0.54–0.83], and the optimal cut-off was 28.8 ng/mL. At multivariable analysis, BL AFP ≥28.8 ng/mL was associated with death [adjusted hazard ratio (aHR) 7.05, 95% CI 1.94–25.71 P = 0.003]. Other factors were HBV infection (aHR 8.57, 95% CI 1.47–50.08, P = 0.017) and treatment allocation (curative vs. noncurative, aHR 0.08, 95% CI 0.02–0.40, P = 0.0004). Conclusions. Our findings suggest that in PLWH AFP serum levels ≥28.8 ng/mL, HBV coinfection and treatment allocation represent predictive markers for death at the time of HCC diagnosis.

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“…Previous studies have reported that adherence to BCLC guidelines was poor in BCLC C patients [9,21,22]. Poor adherence among these patients may be due to some of them being treated with a single drug, sorafenib, which is suboptimal in tolerability and efficacy.…”

Section: Discussionmentioning

confidence: 99%

Real world clinical practice in treating advanced hepatocellular carcinoma: When East meets West

et al. 2020

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Background and aims The Barcelona Clinic Liver Cancer (BCLC) stage C (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population for which sorafeninb is one of the recommended therapies. We aim to evaluate the real world clinical treatment and survival of BCLC stage C patients in an Asian cohort. Methods This is a retrospective cohort study that enrolled 427 consecutive BCLC stage C patients diagnosed between 2011 and 2017 by using the HCC registry data for our hospital. All patients were managed via a multidisciplinary team (MDT) approach. Results Hepatitis B surface antigen positive was noted in 50.6% of the patients. The patients were classified as performance status (PS)1 alone (n = 83; 19.4%), PS2 alone (n = 23; 5.4%), or macrovascular invasion (MVI) or extrahepatic spread (EHS) (n = 321; 75.2%). The median overall survival (OS) was 11.0 months in the whole cohort. The most frequent treatments were transcatheter arterial embolization (TAE) in the PS1 (45.8%) and PS2 patients (52.2%) and sorafenib (32.4%) in the MVI or EHS patients. The independent prognostic factors were the PS, Child-Pugh class, MVI or EHS, alpha fetoprotein levels, and treatment type. Conclusions We reported the real world management in BCLC stage C patients in an Asian cohort through the use of personalized management via a MDT approach.

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Adherence to Barcelona Clinic Liver Cancer guidelines in field practice: Results of Progetto Epatocarcinoma Campania

Abstract: Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.

Cited by 20 publications

References 29 publications

Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

Levels of Alpha-Fetoprotein and Association with Mortality in Hepatocellular Carcinoma of HIV-1-Infected Patients

Real world clinical practice in treating advanced hepatocellular carcinoma: When East meets West

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