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Multimodality treatment of hepatocellular carcinoma: How field practice complies with international recommendations
Author(s) -
Sangiovanni Angelo,
Triolo Michela,
Iavarone Massimo,
Forzenigo Laura V.,
Nicolini Antonio,
Rossi Giorgio,
La Mura Vincenzo,
Colombo Massimo,
Lampertico Pietro
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13888
Subject(s) - medicine , hepatocellular carcinoma , liver cancer , gastroenterology
Background Management of hepatocellular carcinoma ( HCC ) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. Aim We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver ( AASLD ). Methods 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. Results 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. Conclusions 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.