Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm

Richani, Mandy; Kolly, Philippe; Knoepfli, Marina; Herrmann, Evelyn; Zweifel, Martin; von Tengg-Kobligk, Hendrik; Candinas, Daniel; Dufour, Jean-François (2016). Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm. Annals of hepatology, 15(1), pp. 82-90. Sociedad Mexicana de Hepatologia

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BACKGROUND AND AIMS

The Barcelona Clinic Liver Cancer (BCLC) staging system is the algorithm most widely used to manage patients with hepatocellular carcinoma (HCC). We aimed to investigate the extent to which the BCLC recommendations effectively guide clinical practice and assess the reasons for any deviation from the recommendations.

MATERIAL AND METHODS

The first-line treatments assigned to patients included in the prospective Bern HCC cohort were analyzed.

RESULTS

Among 223 patients included in the cohort, 116 were not treated according to the BCLC algorithm. Eighty percent of the patients in BCLC stage 0 (very early HCC) and 60% of the patients in BCLC stage A (early HCC) received recommended curative treatment. Only 29% of the BCLC stage B patients (intermediate HCC) and 33% of the BCLC stage C patients (advanced HCC) were treated according to the algorithm. Eighty-nine percent of the BCLC stage D patients (terminal HCC) were treated with best supportive care, as recommended. In 98 patients (44%) the performance status was disregarded in the stage assignment.

CONCLUSION

The management of HCC in clinical practice frequently deviates from the BCLC recommendations. Most of the curative therapy options, which have well-defined selection criteria, were allocated according to the recommendations, while the majority of the palliative therapy options were assigned to patients with tumor stages not aligned with the recommendations. The only parameter which is subjective in the algorithm, the performance status, is also the least respected.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology
UniBE Contributor:	Herrmann, Evelyn, Zweifel, Martin, von Tengg-Kobligk, Hendrik, Candinas, Daniel, Dufour, Jean-François
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1665-2681
Publisher:	Sociedad Mexicana de Hepatologia
Language:	English
Submitter:	Beatrice Scheidegger
Date Deposited:	06 Apr 2016 16:45
Last Modified:	05 Dec 2022 14:52
PubMed ID:	26626644
URI:	https://boris.unibe.ch/id/eprint/77028