Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy

• Published in: Asian Pacific journal of cancer prevention : APJCP Vol. 16; no. 16; pp. 6929 - 6934
• Main Authors: Alkhatib, Alzhraa, Gomaa, Asmaa, Allam, Naglaa, Rewisha, Eman, Waked, Imam
• Format: Journal Article
• Language: Korean
• Published: 2015
• Subjects: barcelona clinic liver cancer; AASLD guidelines; survival; hepatocellular carcinoma
• ISSN: 1513-7368; 2476-762X

Background: Real life management of hepatocellular carcinoma occasionally deviates from guidelines for recommended therapy. Aims: To evaluate how frequent this deviation happens in our center and assess its impact on outcome. Materials and Methods: The treatment of 770 patients (87% males, mean age 57.8 years) was analyzed and the effect of deviation on outcome over 36 months was examined. Results: Of Barcelona Clinic liver cancer stages 0 and A patients, 65.8% received resection, ablation, liver transplantation or transarterial chemoembolisation for unresectable tumors more than 5 cm in diameter, and 34.2% received treatment recommended for later stages. Of stage B patients, 62.2% received recommended therapy, 34.3% of patients received supportive therapy or sorafenib and 3.5% received upward treatment stage migration. Among stage C patients, 7.6% received sorafenib, and most (79.2%) were given supportive care. Deviation from recommended therapy occurred in 34.2%, 37.7%, and 92.4% in stages 0-A, B and C. Survival of stage 0-A patients who received downwards treatment stage migration was lower than those who received recommended treatment (p <0.001). Upward treatment stage migration in stages B, C and D did not improve survival compared to those who received recommended treatment. Conclusions: Deviation from recommended therapy had a negative impact on survival in Barcelona Clinic liver cancer stage A patients.