Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient...

Area of Science:

• Hepatobiliary oncology
• Clinical treatment strategies
• Cancer research

Background:

• The Barcelona Clinic Liver Cancer (BCLC) classification system provides treatment guidelines for hepatocellular carcinoma (HCC).
• Multidisciplinary tumor boards (MDTs) offer individualized patient care, potentially diverging from standardized guidelines.

Purpose of the Study:

• To assess treatment allocation and outcomes in HCC patients managed through an individualized, multidisciplinary approach.
• To evaluate deviations from BCLC first-treatment recommendations within an MDT setting.

Main Methods:

• Retrospective analysis of treatment-naïve HCC patients discussed at MDT from 2010-2013.
• Documentation of MDT first-treatment recommendations and subsequent therapies.
• Overall survival (OS) analysis stratified by BCLC stage using intention-to-treat (ITT).

Main Results:

• A total of 321 HCC patients were included, with a median age of 62 years; 73% were male, 41% had hepatitis C.
• 76% of patients received first-treatment recommendations discordant with BCLC guidelines.
• Median OS varied by BCLC stage: not reached (Stage A), 51.0 months (Stage B), 25.4 months (Stage C), and 13.4 months (Stage D).

Conclusions:

• Deviation from BCLC guidelines is common in MDT-based individualized HCC treatment.
• The individualized approach met expected OS for BCLC Stage A and exceeded expectations for BCLC Stages B, C, and D.
• Personalized treatment strategies, considering center expertise and patient specifics, can improve HCC outcomes beyond standard guidelines.