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

Abstract

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.

Living donor liver transplantation for Barcelona clinic liver cancer (BCLC) intermediate-stage hepatocellular carcinoma

“…In contrast to the LDLT group, the non-LDLT group had relatively more complex LRT, including resection (n=1,026, 48.9%), TA(C)E (n=1,502, 51.4%), RFA (n=251, 8.6%), sorafenib treatment (n=24, 0.8%), best supportive care (BSC) (n=36, 1.2%), and other factors (i.e., systemic chemotherapy, hepatic artery infusion chemotherapy, or external beam radiation therapy; n=81, 2.8%). These observations are reasonable and compatible with our prior study ( 26 ). Even though the treatment choices differed between the two groups, TA(C)E currently remains the main treatment of choice for BCLC stage B HCC.…”

Survival outcomes in veterans with hepatocellular carcinoma, with and without HIV infection

“…Adherence to AASLD guidelines in our study was low (57%) and similar to levels seen in other studies (60–65%) [27–32]. In our study, the most common reasons for guideline-nonconcordant treatment were not being medically eligible due to a comorbidity, and receiving more aggressive treatment than recommended per AASLD treatment guidelines (which recommends HCC treatment based on BCLC stage).…”

Characteristics and survival of patients with primary biliary cholangitis and hepatocellular carcinoma

“…This was mainly due to the very high proportion (42.6%) of patients whose HCC was diagnosed outside surveillance who received a curative treatment, a finding related to the generally preserved liver function of this HCC population. In fact, good residual liver function permits to treat unfavorable tumor stages with an upward, more aggressive approach outside pre-determined stage-linked recommendations, eventually leading to improved survival [30][31][32][33] . These findings emphasize once again two concepts: first, the main determinant of survival in patients with HCC is the receipt of treatments with curative intent; second, the association between survival and surveillance is a proxy of a higher eligibility rate to such treatments among patients under surveillance [34] .…”