Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

• Published in: PloS one Vol. 16; no. 3; p. e0249194
• Main Authors: Yen, Yi-Hao, Cheng, Yu-Fan, Wang, Jing-Houng, Lin, Chih-Che, Chen, Chien-Hung, Wang, Chih-Chi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.03.2021; Public Library of Science (PLoS)
• Subjects: Albumins; Ascites; Bilirubin; Biology and life sciences; Drafting software; Etiology; Flow charts; Health care policy; Health insurance; Hepatitis; Hepatocellular carcinoma; Hospitals; Internal medicine; Liver; Liver cancer; Liver cirrhosis; Liver diseases; Liver transplantation; Liver transplants; Magnetic resonance imaging; Medical prognosis; Medical records; Medical schools; Medicine; Medicine and Health Sciences; Patients; Prothrombin; Radiology; Surgery; Transaminase; Transplantation; Transplants & implants; Tumors; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0249194

The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely applied staging system for hepatocellular carcinoma (HCC) and is recommended for treatment allocation and prognostic prediction. The BCLC guidelines were modified in 2018 to indicate that Child-Pugh A without any ascites is essential for all stages except stage D. This study sought to provide a description of patients with HCC treated at a high-volume liver surgery center in Taiwan where referral is not needed and all treatment modalities are available and reimbursed by the National Health Insurance program. As such, certain variables that could modulate treatment decisions in clinical practice, including financial constraints, the availability of treatment procedures, and the expertise of the hospital, could be excluded. The study further sought to evaluate the adherence to the modified BCLC guidelines. This was a retrospective study with prospectively collected data. 1801 consecutive patients with de novo HCC were enrolled through our institution from 2011-2017. There were 302 patients with stage 0, 783 with stage A, 242 with stage B, 358 with stage C, and 116 with stage D HCC. Treatment adhering to the modified BCLC guidelines recommendations was provided to 259 (85.8%) stage 0 patients, 606 (77.4%) stage A patients, 120 (49.6%) stage B patients, 93 (26.0%) stage C patients, and 83 (71.6%) stage D patients. We reported treatment adhering to the modified BCLC guidelines at a high-volume liver surgery center in Taiwan. We found that non-adherence to the modified BCLC staging system was common in treating stage B and C patients.