Real world clinical practice in treating advanced hepatocellular carcinoma: When East meets West

PLoS One. 2020 Mar 12;15(3):e0230005. doi: 10.1371/journal.pone.0230005. eCollection 2020.

Abstract

Background and aims: The Barcelona Clinic Liver Cancer (BCLC) stage C (BCLC C) of hepatocellular carcinoma (HCC) includes a heterogeneous population for which sorafeninb is one of the recommended therapies. We aim to evaluate the real world clinical treatment and survival of BCLC stage C patients in an Asian cohort.

Methods: This is a retrospective cohort study that enrolled 427 consecutive BCLC stage C patients diagnosed between 2011 and 2017 by using the HCC registry data for our hospital. All patients were managed via a multidisciplinary team (MDT) approach.

Results: Hepatitis B surface antigen positive was noted in 50.6% of the patients. The patients were classified as performance status (PS)1 alone (n = 83; 19.4%), PS2 alone (n = 23; 5.4%), or macrovascular invasion (MVI) or extrahepatic spread (EHS) (n = 321; 75.2%). The median overall survival (OS) was 11.0 months in the whole cohort. The most frequent treatments were transcatheter arterial embolization (TAE) in the PS1 (45.8%) and PS2 patients (52.2%) and sorafenib (32.4%) in the MVI or EHS patients. The independent prognostic factors were the PS, Child-Pugh class, MVI or EHS, alpha fetoprotein levels, and treatment type.

Conclusions: We reported the real world management in BCLC stage C patients in an Asian cohort through the use of personalized management via a MDT approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / therapy*
  • Embolization, Therapeutic*
  • Female
  • Hepatitis B Surface Antigens / blood
  • Humans
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Sorafenib / therapeutic use
  • Survival Analysis
  • Vascular Neoplasms / diagnosis
  • Vascular Neoplasms / secondary
  • alpha-Fetoproteins / analysis

Substances

  • Antineoplastic Agents
  • Hepatitis B Surface Antigens
  • alpha-Fetoproteins
  • Sorafenib

Grants and funding

Financial support: This study was supported by Grant CMRPG8J1281 from the Kaohsiung Chang Gung Memorial Hospital, Taiwan. Grant Recipient is Yi-Hao Yen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.