Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
Hepatology Unit, "Cardarelli" Hospital, Naples, Italy.
J Gastroenterol Hepatol. 2018 May;33(5):1123-1130. doi: 10.1111/jgh.14013. Epub 2018 Feb 7.
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.
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.
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.
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.
巴塞罗那临床肝癌（BCLC）算法是肝细胞癌（HCC）临床管理的标准系统。关于遵守该治疗范例的数据很少。本现场实践研究旨在提供意大利南部 HCC 肝硬化患者的描述，评估对 BCLC 指南的遵守情况及其对患者生存的影响。
我们分析了意大利坎帕尼亚肝癌项目的全地区数据库，该数据库包含了 2013 年 1 月至 2015 年 12 月在 16 个地区中心前瞻性收集的 HCC 肝硬化患者的数据。
共有 1008 名 HCC 患者入组：70.6%的患者接受了 BCLC 算法推荐的治疗方法，而 29.4%的患者接受了不同的治疗方法。在遵守指南治疗的患者中，观察到更多的患者在监测计划中得到诊断，肝功能更好，甲胎蛋白>200ng/ml 的比例更低，早期和单病灶 HCC 的比例更高，结节>5cm 的比例更低，门静脉血栓形成和转移的频率更低。根据 HCC 分期评估总生存率，未发现组间差异和不同治疗管理的患者之间存在差异。多变量分析表明，不遵守治疗指南与 BCLC 分期 B、Child-Pugh 分级 B 和 C 以及肿瘤血栓形成和转移的存在独立相关。
在现场实践中，早期和终末期 HCC 患者对 BCLC 算法的依从性较高，但中期和晚期患者的依从性较差。
