Cargando…

Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage

OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study inclu...

Descripción completa

Detalles Bibliográficos
Autores principales: Kikuchi, Luciana, Chagas, Aline Lopes, Alencar, Regiane S.S.M., Tani, Claudia, Diniz, Marcio A., D’Albuquerque, Luiz A.C., Carrilho, Flair José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577619/
https://www.ncbi.nlm.nih.gov/pubmed/28954003
http://dx.doi.org/10.6061/clinics/2017(08)01
_version_ 1783260376979210240
author Kikuchi, Luciana
Chagas, Aline Lopes
Alencar, Regiane S.S.M.
Tani, Claudia
Diniz, Marcio A.
D’Albuquerque, Luiz A.C.
Carrilho, Flair José
author_facet Kikuchi, Luciana
Chagas, Aline Lopes
Alencar, Regiane S.S.M.
Tani, Claudia
Diniz, Marcio A.
D’Albuquerque, Luiz A.C.
Carrilho, Flair José
author_sort Kikuchi, Luciana
collection PubMed
description OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09–0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67–9.88; p<0.001), whereas no differences were observed in patients in stages B or C. CONCLUSIONS: The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.
format Online
Article
Text
id pubmed-5577619
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
record_format MEDLINE/PubMed
spelling pubmed-55776192017-09-05 Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage Kikuchi, Luciana Chagas, Aline Lopes Alencar, Regiane S.S.M. Tani, Claudia Diniz, Marcio A. D’Albuquerque, Luiz A.C. Carrilho, Flair José Clinics (Sao Paulo) Clinical Science OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09–0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67–9.88; p<0.001), whereas no differences were observed in patients in stages B or C. CONCLUSIONS: The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2017-08 2017-08 /pmc/articles/PMC5577619/ /pubmed/28954003 http://dx.doi.org/10.6061/clinics/2017(08)01 Text en Copyright © 2017 CLINICS http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
spellingShingle Clinical Science
Kikuchi, Luciana
Chagas, Aline Lopes
Alencar, Regiane S.S.M.
Tani, Claudia
Diniz, Marcio A.
D’Albuquerque, Luiz A.C.
Carrilho, Flair José
Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
title Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
title_full Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
title_fullStr Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
title_full_unstemmed Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
title_short Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
title_sort adherence to bclc recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577619/
https://www.ncbi.nlm.nih.gov/pubmed/28954003
http://dx.doi.org/10.6061/clinics/2017(08)01
work_keys_str_mv AT kikuchiluciana adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage
AT chagasalinelopes adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage
AT alencarregianessm adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage
AT taniclaudia adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage
AT dinizmarcioa adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage
AT dalbuquerqueluizac adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage
AT carrilhoflairjose adherencetobclcrecommendationsforthetreatmentofhepatocellularcarcinomaimpactonsurvivalaccordingtostage