Barcelona Clinic Liver Cancer strategy adherence in hepatocellular carcinoma and its influence on long-term outcomes

Hepatocellular carcinoma (HCC) survival rates remain poor. This retrospective study evaluated the adherence to the Barcelona Clinic Liver Cancer (BCLC) treatment strategy for HCC in a real-world setting and the effect of deviation from the strategy on long-term outcomes.

We retrospectively analysed all histologically confirmed HCC cases that received invasive treatment at Oulu University Hospital 1986-2022 and Central Finland Central Hospital 1997-2022. Adherence to the BCLC strategy was re-evaluated according to: (I) tumor burden, (II) liver function, (III) patient profile, and (IV) surgical technique. Patients were re-evaluated according to the BCLC strategy of the year of treatment.

Among 208 total patients, 93 received surgical treatment, 29 underwent local ablative treatment, and 86 received transarterial treatment. Altogether, 145 (69.7%) patients were treated according to the BCLC strategy. Patients who received surgical treatment according to the BCLC strategy (n=76) had superior survival outcomes than those treated surgically outside the strategy (n=17), with 1-, 3-, and 5-year survival rates of 92.1%, 84.2%, and 78.9%, compared to 82.4%, 41.2%, and 23.5%, respectively (P<0.001).

Our findings suggest that adherence to the BCLC strategy is associated with improved survival outcomes in a real-world setting. Patients treated outside the strategy should be carefully selected.