1079 Advanced HCC Management in Clinical Practice Evolves Beyond BCLC Guideline

Abstract

INTRODUCTION: Hepatocellular carcinoma (HCC) represents 90% of all primary liver cancer and is the fifth commonest malignancy. BCLC staging and treatment recommendations have been adopted worldwide as standard of care for HCC management. Hence, Australian practice was reviewed over heterogeneous period of time in two main tertiary centres; Royal Prince Alfred Hospital (RPA) and Westmead Hospital (WM). METHODS: After obtaining ethics approval, 838 patients underwent active HCC surveillance, with 597 being followed-up at WM and 241 being followed-up at RPA. Cirrhosis staging and HCC staging were recorded as well as treatment received and survival outcomes of the 95 patients who developed HCC. RESULTS: More than half of the HCC patients (61%) were BCLC stage 0 or A at diagnosis when they are eligible for curative treatments. BCLC-0 patients were appropriately treated with liver resection or locoregional therapy (LRT). All achieved adequate disease control without requiring further therapy. BCLC-A patients were treated with liver resection, liver transplant (LT) and LRT at a rate of 24%, 9% and 63% respectively. Half of the liver resection patients had HCC recurrence and required LRT, but eventually went on to have sorafenib. Two patients from the LRT primary treatment group (7% of this subgroup) went on to have sorafenib. Deviating from BCLC guideline, one patient (8%) from the BCLC-B group received liver transplant and continued to enjoy cancer-free survival. Two patients (17%) from BCLC-B group had liver resection; one of them had HCC recurrence and received sorafenib as salvage therapy. Only a quarter of BCLC-C patients received sorafenib as primary therapy in accordance with BCLC guideline. The other 75% of BCLC-C patients received LRT first, and eventually went on to have sorafenib as secondary treatment. Most surprisingly, as primary treatment two of the 17 BCLC-D patients (12%) received sorafenib and 7 (17%)received LRT. Only 8 of them (47%) were managed according to BCLC guideline and received palliative care first. CONCLUSION: In this multi-centre HCC cohort, BCLC-0 and A patients were treated in accordance with BCLC guideline. However, some of our BCLC-B patients also received LT or liver resection and enjoyed positive survival outcome. Interestingly, the majority of BCLC-C and 17% of BCLC-D patients received LRT. The difference in practice may be attributed to increasingly published data on survival benefits of giving LRT to BCLC late stage patients.