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

Abstract

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.

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

“…The EASL guidelines recommend that LR only be considered for minor branch PVTT of HCC (Vp1 or Vp2) [ 6 ]. At the investigated hospital, LR can be considered for PVTT limited to the first-order branch (Vp3) [ 29 ], and the outcomes are acceptable, as reported in our previous study [ 34 ]. A significant proportion of the patients with stage C HCC in this study underwent other treatments because sorafenib was reimbursed for selected stage C patients.…”

Revisiting Hepatic Artery Infusion Chemotherapy in the Treatment of Advanced Hepatocellular Carcinoma

“…Retrospective studies focusing on patients with PVT have revealed that patients receiving HAIC had a longer OS compared with those receiving sorafenib treatment [ 22 , 28 ]. HAIC also provided survival benefits for large HCC as shown in retrospective studies [ 32 , 33 ], and also in a randomized Phase 3 study comparing HAIC and TACE in large (>7 cm) intermediate HCC [ 34 ]. Adverse events of HAIC in these studies were relatively low [ 32 , 34 ].…”

Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes

“…Several recent studies, however, have suggested that patients with symptomatic HCC without MVI or EHS should not be regarded as having advanced-stage disease. Furthermore, patients with advanced HCC without MVI or EHS in a real-world setting have frequently been treated with locoregional therapy, such as transarterial chemoembolization (TACE) (6)(7)(8)(9)(10). The efficacy of TACE, however, has been insufficiently defined, and factors associated with prognosis in patients treated with TACE remain unclear.…”