Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Diagnostic Radiology, Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2021 Mar 25;16(3):e0249194. doi: 10.1371/journal.pone.0249194. eCollection 2021.
The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely applied staging system for hepatocellular carcinoma (HCC) and is recommended for treatment allocation and prognostic prediction. The BCLC guidelines were modified in 2018 to indicate that Child-Pugh A without any ascites is essential for all stages except stage D. This study sought to provide a description of patients with HCC treated at a high-volume liver surgery center in Taiwan where referral is not needed and all treatment modalities are available and reimbursed by the National Health Insurance program. As such, certain variables that could modulate treatment decisions in clinical practice, including financial constraints, the availability of treatment procedures, and the expertise of the hospital, could be excluded. The study further sought to evaluate the adherence to the modified BCLC guidelines.
This was a retrospective study with prospectively collected data. 1801 consecutive patients with de novo HCC were enrolled through our institution from 2011-2017.
There were 302 patients with stage 0, 783 with stage A, 242 with stage B, 358 with stage C, and 116 with stage D HCC. Treatment adhering to the modified BCLC guidelines recommendations was provided to 259 (85.8%) stage 0 patients, 606 (77.4%) stage A patients, 120 (49.6%) stage B patients, 93 (26.0%) stage C patients, and 83 (71.6%) stage D patients.
We reported treatment adhering to the modified BCLC guidelines at a high-volume liver surgery center in Taiwan. We found that non-adherence to the modified BCLC staging system was common in treating stage B and C patients.
巴塞罗那临床肝癌（BCLC）分期系统是最广泛应用于肝细胞癌（HCC）的分期系统，推荐用于治疗分配和预后预测。2018 年对 BCLC 指南进行了修订，指出除了 D 期以外，所有阶段均需要 Child-Pugh A 且无腹水。本研究旨在描述在台湾一家高容量肝脏外科中心接受治疗的 HCC 患者，该中心无需转诊，所有治疗方法均可用，并由全民健康保险计划报销。因此，可以排除可能影响临床实践中治疗决策的某些变量，包括经济限制、治疗程序的可用性和医院的专业知识。该研究进一步旨在评估对改良 BCLC 指南的遵守情况。
这是一项回顾性研究，前瞻性收集数据。2011 年至 2017 年，通过我们的机构纳入了 1801 例初发 HCC 连续患者。
有 302 例患者为 0 期，783 例为 A 期，242 例为 B 期，358 例为 C 期，116 例为 D 期 HCC。259 例（85.8%）0 期患者、606 例（77.4%）A 期患者、120 例（49.6%）B 期患者、93 例（26.0%）C 期患者和 83 例（71.6%）D 期患者接受了符合改良 BCLC 指南建议的治疗。
我们报告了在台湾一家高容量肝脏外科中心遵守改良 BCLC 指南的治疗情况。我们发现，在治疗 B 期和 C 期患者时，不遵守改良 BCLC 分期系统的情况很常见。
