4:12 PM Abstract No. 269 Modern multidisciplinary management of hepatocellular carcinoma: deviation from BCLC guidelines does not alter survival

Abstract

The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely used hepatocellular carcinoma (HCC) guideline. However, the BCLC system is criticized for its limited applicability in many clinical scenarios. In this study, we compared treatment recommendations from our multidisciplinary team to those recommended by the BCLC stage for patients designated BCLC stage 0 through stage D. With IRB approval, we included all new diagnoses of HCC discussed from 2010 to 2013 at our multidisciplinary tumor board, yielding 349 patients. The criteria for BCLC status at presentation were recorded. Tumor board recommendations for treatment, as well as BCLC recommendations were compared. Kaplan–Meier survival analyses were performed from the date of the first treatment, censored to curative treatment, to determine survival based on BCLC stage. The log-rank test was used to compare survival rates, with a P<0.05 considered significant. Of the 349 treatment-naïve patients 22 patients were BCLC 0, 153 were BCLC A, 31 were BCLC B, 97 were BCLC C, and 46 were BCLC D. Following multidisciplinary tumor board discussion, 79.9% (n = 279) received treatment recommendations discordant from BCLC recommendations. Intra-arterial therapy (chemoembolization or radioembolization) was used in 257 (73.6%) patients, discordant from BCLC recommendations. There was no significant difference in survival between patients who received BCLC treatment recommendations and those who did not (median survival 23.5 mos vs 24.2 mos, respectively, p = 0.21). Additionally, when substratified by BCLC stage, there were no significant differences in survival between those who followed BCLC treatment recommendations, and those who did not (p = 0.12). Determining HCC treatment requires a multidisciplinary approach. In this analysis of treatment naïve HCC, deviation from BCLC recommendations yielded no significant difference in overall survival, even when substratified by BCLC stage. As part of individualization of patient care, primary treatments often deviate from BCLC recommendations due to unique clinical scenarios not captured by BCLC. This analysis supports the concepts of individualized patient care.