Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for the study of Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Division of Internal Medicine, Policlinico S. Donato, University of Milan, San Donato Milanese, Italy.
Liver Int. 2018 Sep;38(9):1624-1634. doi: 10.1111/liv.13888. Epub 2018 Jul 15.
Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining.
We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD).
370 consecutive cirrhotic patients with de novo HCC in different stages, 253 BCLC A, 66 BCLC B, 51 BCLC C received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up.
Treatment was adherent to AASLD recommendations in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third-line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared with other treatment (5.0% vs 10.4% P = .004), whereas upward treatment stage migration compared with the standard of care was associated with reduced yearly mortality in BCLC B (8.6% vs 20.7%, P = .029) and BCLC C (42.6% vs 59.0%, P = .04) patients.
HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended.
肝细胞癌 (HCC) 的管理框架是基于科学学会发布的标准化方案制定的，但其在现场实践中的适用性和疗效需要进一步优化。
我们评估了美国肝病研究学会 (AASLD) 发布的 HCC 治疗指南的适用性和有效性。
370 例不同分期的初发 HCC 肝硬化患者，253 例 BCLC A 期、66 例 BCLC B 期、51 例 BCLC C 期，通过多学科团队 (MDT) 决策进行治疗，并随访至死亡或随访结束。
205 例 (81%) BCLC A 期、36 例 (54%) BCLC B 期和 27 例 (53%) BCLC C 期患者的治疗符合 AASLD 建议。一线治疗后，165 例 (45%)患者获得完全缓解，22 例 (19%)患者接受二线治疗，9 例 (23%)患者接受三线治疗。与其他治疗相比，BCLC A 期患者遵循 AASLD 建议可降低每年平均死亡率（5.0% vs 10.4%，P=0.004），而与标准治疗相比，向上治疗阶段迁移与 BCLC B 期（8.6% vs 20.7%，P=0.029）和 BCLC C 期（42.6% vs 59.0%，P=0.04）患者的每年死亡率降低相关。
多模式 HCC 治疗包括一线治疗以外的治疗方法在临床实践中很常见，并影响完全缓解的实现。个体化治疗能够为不符合国际建议的患者提供生存获益，这些建议需要进行修正。
