Open AccessReal-World Data on Clinical Outcomes of Patients with Liver Cancer: A Prospective Validation of the National Cancer Centre Singapore Consensus Guidelines for the Management of Hepatocellular Carcinoma
Author(s) -
Chew Xin Hui,
Sultana Rehena,
Mathew Eshani N.,
Ng David Chee Eng,
Lo Richard H.G.,
Toh Han Chong,
Tai David,
Choo Su Pin,
Goh Brian Kim Poh,
Yan Sean Xuexian,
Loke Kelvin Siu Hoong,
Thang Sue Ping,
Gogna Apoorva,
Venkatanarasimha Nanda Karaddi,
Tong Aaron K.T.,
Moe Fio.N.,
Chua Jacelyn S.S.,
Ang Reiko W.T.,
Ong Aldwin D.,
Ng Ashley W.Y.,
Hoang Marjorie T.Q.,
Too Chow Wei,
Thng Choon Hua,
Chan Wan Ying,
Kee Wanyi,
Chan Jaclyn H. M.,
Irani Farah,
Leong Sum,
Lim Kiat Hon,
Wang Michael L.C.,
Chow Pierce K.H.
Publication year - 2021
Publication title -
liver cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.916
H-Index - 34
eISSN - 1664-5553
pISSN - 2235-1795
DOI - 10.1159/000514400
Subject(s) - consensus guidelines
Real-world management of patients with hepatocellular carcinoma (HCC) is crucially challenging in the current rapidly evolving clinical environment which includes the need for respecting patient preferences and autonomy. In this context, regional/national treatment guidelines nuanced to local demographics have increasing importance in guiding disease management. We report here real-world data on clinical outcomes in HCC from a validation of the Consensus Guidelines for HCC at the National Cancer Centre Singapore (NCCS). Method: We evaluated the NCCS guidelines using prospectively collected real-world data, comparing the efficacy of treatment received using overall survival (OS) and progression-free survival (PFS). Treatment outcomes were also independently evaluated against 2 external sets of guidelines, the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC). Results: Overall treatment compliance to the NCCS guidelines was 79.2%. Superior median OS was observed in patients receiving treatment compliant with NCCS guidelines for early (nonestimable vs. 23.5 months p < 0.0001), locally advanced (28.1 vs. 22.2 months p = 0.0216) and locally advanced with macrovascular invasion (10.3 vs. 3.3 months p = 0.0013) but not for metastatic HCC (8.1 vs. 6.8 months p = 0.6300), but PFS was similar. Better clinical outcomes were seen in BCLC C patients who received treatment compliant with NCCS guidelines than in patients with treatment only allowed by BCLC guidelines (median OS 14.2 vs. 7.4 months p = 0.0002; median PFS 6.1 vs. 4.0 months p = 0.0286). Clinical outcomes were, however, similar for patients across all HKLC stages receiving NCCS-recommended treatment regardless of whether their treatment was allowed by HKLC. Conclusion: The high overall compliance rate and satisfactory clinical outcomes of patients managed according to the NCCS guidelines confirm its validity. This validation using real-world data considers patient and treating clinician preferences, thus providing a realistic analysis of the usefulness of the NCCS guidelines when applied in the clinics.