Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
Clinics
;
72(8): 454-460, Aug. 2017. tab, graf
Article
in English
| LILACS
| ID: biblio-890722
ABSTRACT
OBJECTIVES:
This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease.METHODS:
This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test.RESULTS:
The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI) 0.09-0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI 1.67-9.88; p<0.001), whereas no differences were observed in patients in stages B or C.CONCLUSIONS:
The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Carcinoma, Hepatocellular
/
Guideline Adherence
/
Liver Neoplasms
Type of study:
Practice guideline
/
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
Clinics
Journal subject:
Medicine
Year:
2017
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade de São Paulo/BR
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