TY - JOUR
T1 - Adherence to Barcelona Clinic Liver Cancer guidelines in field practice
T2 - Results of Progetto Epatocarcinoma Campania
AU - Guarino, Maria
AU - Tortora, Raffaella
AU - de Stefano, Giorgio
AU - Coppola, Carmine
AU - Morisco, Filomena
AU - Salomone Megna, Angelo
AU - Izzo, Francesco
AU - Nardone, Gerardo
AU - Piai, Guido
AU - Adinolfi, Luigi Elio
AU - D'Adamo, Giuseppe
AU - Gaeta, Giovanni Battista
AU - Messina, Vincenzo
AU - Francica, Giampiero
AU - De Girolamo, Vincenzo
AU - Coppola, Nicola
AU - Persico, Marcello
AU - Di Costanzo, Giovan Giuseppe
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background and Aim: The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival. Methods: We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers. Results: Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha-fetoprotein > 200 ng/mL, more early-stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B and C, and the presence of neoplastic thrombosis and metastases. Conclusion: Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.
AB - Background and Aim: The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival. Methods: We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers. Results: Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha-fetoprotein > 200 ng/mL, more early-stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B and C, and the presence of neoplastic thrombosis and metastases. Conclusion: Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.
KW - Adherence
KW - BCLC
KW - Guidelines
KW - Hepatocellular carcinoma
KW - Treatment
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U2 - 10.1111/jgh.14013
DO - 10.1111/jgh.14013
M3 - Article
AN - SCOPUS:85041688956
JO - Journal of Gastroenterology and Hepatology (Australia)
JF - Journal of Gastroenterology and Hepatology (Australia)
SN - 0815-9319
ER -