Treatment of hepatocellular carcinoma in a tertiary Romanian center. Deviations from BCLC recommendations and influence on survival rate.

Background & Aim: The Barcelona-Clinic Liver Cancer (BCLC) staging system is based on the results obtained in the setting of several cohort studies and randomized clinical trials. We have evaluated the applicability of the BCLC staging system and the effect of treatment allocation according to BCLC on the survival rate and prognosis in patients with hepatocellular carcinoma (HCC) in a tertiary center.

Methods: Treatment indications for 473 patients referred to our center with the diagnosis of HCC were retrospectively analyzed. Patients were split in three groups: a group treated according to BCLC recommendation, an overtreated group and an undertreated group. The survival rate was calculated using the Kaplan Meier method and compared using the log-rank test.

Results: Patients distribution according to BCLC staging system was: 17 patients (3.6%) in very early stage (O), 161 (34.0 %) in early (A), 140 (29.6%) in intermediate (B), 82 (17.3%) in advanced (C) and 73 patients (15.4%) in terminal stage (D). Only 275 patients (58.1%) from stage 0, A-D were treated according to BCLC. The mean survival rate in stage 0 and A was higher for patients receiving curative treatment in comparison with undertreated patients (41 vs 28 months, p< 0.05). Overtreated patients in stage B or C had a better survival than patients treated according to BCLC (25 months vs 21 months, p=0.973, and 28 months vs 4 months, p=0.308, respectively), without statistical significance. Patients in stage B and C treated according to BCLC recommendations had a better survival than those undertreated (21 months vs 13 months, p=0.002, and 4 vs 3 months, p=0.036, respectively).

Conclusions: Deviations from BCLC recommendations occur in 40% of patients with HCC. Undertreatment results in a decreased survival of patients diagnosed with HCC. Overtreated BCLC-B and C patients have an increased survival in comparison with those treated with standard therapy.