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Multimodality treatment of hepatocellular carcinoma: How field practice complies with international recommendations

Angelo Sangiovanni1, Michela Triolo2, Massimo Iavarone1

  • 1Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.

Liver International : Official Journal of the International Association for the Study of the Liver
|May 24, 2018
PubMed

Insights

Standard hepatocellular carcinoma (HCC) guidelines need refinement. Personalized treatment plans improved survival for patients not fitting standard criteria, suggesting guidelines require updates for better HCC management.

Area of Science:

  • Hepatology
  • Oncology
  • Clinical Medicine

Background:

  • Standardized protocols for hepatocellular carcinoma (HCC) management exist but require real-world validation.
  • The applicability and efficacy of established guidelines in clinical practice are under scrutiny.

Purpose of the Study:

  • To evaluate the practical application and effectiveness of American Association for the Study of Liver Diseases (AASLD) guidelines for HCC treatment.
  • To assess guideline adherence and patient outcomes across different stages of HCC.

Main Methods:

  • A cohort of 370 cirrhotic patients with de novo HCC, stratified by Barcelona Clinic Liver Cancer (BCLC) stage (A, B, C), were treated based on multidisciplinary team decisions.
  • Treatment adherence to AASLD recommendations was recorded, and patient outcomes, including radiological response and mortality rates, were tracked.

Main Results:

  • AASLD guideline adherence varied by BCLC stage (81% for A, 54% for B, 53% for C).
  • Complete radiological response rates were 45% after first-line, 19% after second-line, and 23% after third-line treatment.
  • Adherence to AASLD guidelines correlated with lower mortality in BCLC A, while treatment upstaging improved survival in BCLC B and C.

Conclusions:

  • Multimodality HCC treatment beyond first-line therapy is frequent and impacts complete response rates.
  • Personalized treatment strategies offer survival advantages for patients outside standard guideline profiles.
  • International HCC recommendations require amendment to better incorporate diverse patient profiles and improve outcomes.
Abstract

Keywords:
BCLC stageHCC treatmentcirrhosishepatocellular carcinoma

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