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Eur J Gastroenterol Hepatol. 2018 Apr;30(4):376-383. doi: 10.1097/MEG.0000000000001049.

Adherence to Barcelona Clinic Liver Cancer therapeutic algorithm for hepatocellular carcinoma in the daily practice: a multicenter cohort study from Argentina.

Author information

1
School of Medicine, Austral University Hospital, Pilar.
2
Sanatorio Trinidad San Isidro.
3
Clínica Privada San Fernando.
4
Hospital Italiano.
5
Hospital Británico, Catholic University from Argentina (UCA).
6
Hospital G Rawson, San Juan, Argentina.
7
Hospital del Centenario, Rosario, Santa Fe.
8
Hospital Alemán.
9
Hospital Privado, Córdoba.
10
Centre of Medical Education and Clinical Research Norberto Quirno (CEMIC).
11
Hospital Udaondo.
12
Hospital Ramos Mejía.
13
Center of Ambulatory Medical Specialities (CEMA), Mar del Plata.
14
Nefrology Clinic.
15
Institute of Clinical Efficiency and Public Health (IECS), Buenos Aires.

Abstract

BACKGROUND AND AIM:

Adherence to the Barcelona Clinic Liver Cancer (BCLC) staging algorithm for the treatment of hepatocellular carcinoma is challenging in the daily practice. We aimed to analyze adherence to BCLC along with its effect on patient survival.

PATIENTS AND METHODS:

A cohort study was conducted in 14 hospitals from Argentina including patients with newly diagnosed hepatocellular carcinoma (2009-2016). Adherence was considered when the first treatment was the one recommended by the BCLC.

RESULTS:

Overall, 708 patients were included. At diagnosis, BCLC stages were as follows: stage 0 4%, A 43%, B 22%, C 9% and D 22%. Overall, 53% of the patients were treated according to BCLC, 24% were undertreated, and 23% overtreated. Adherence to BCLC increased to 63% in subsequent treatments. Independent factors associated with adherence to BCLC were the presence of portal hypertension [odds ratio: 1.63; 95% confidence interval (CI): 1.11-2.39] and BCLC stage C (odds ratio: 0.32; 95% CI: 0.12-0.72). In a multivariable model adjusting for portal hypertension and BCLC stages, adherence to BCLC showed improved survival (hazard ratio: 0.67; 95% CI: 0.52-0.87).

CONCLUSION:

Adherence to BCLC represents a challenge in the daily practice, with almost half of the patients being treated accordingly, showing that the decision-making process should be tailored to each individual patient.

PMID:
29509603
DOI:
10.1097/MEG.0000000000001049
[Indexed for MEDLINE]

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