Why Cannot BCLC 0- or A-Stage Patients Receive Curative Treatment?

Tse-Ming Kuo; Kai-Ming Chang; Kuo-Jang Kao

doi:10.1159/000509824

Why Cannot BCLC 0- or A-Stage Patients Receive Curative Treatment?

Gastrointest Tumors. 2020 Oct;7(4):125-133. doi: 10.1159/000509824. Epub 2020 Aug 13.

Authors

Tse-Ming Kuo¹, Kai-Ming Chang², Kuo-Jang Kao²

Affiliations

¹ Division of Gastroenterology and Hepatobiliary Disease, Department of Internal Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
² Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.

Abstract

Introduction: Barcelona Clinic Liver Cancer (BCLC) staging has been an important clinical guideline for the management of hepatocellular carcinoma (HCC). BCLC 0 and A stages (BCLC 0/A) have been designated as the early-stage HCC, and the curative treatment is recommended as the primary therapeutic modality. However, a recent study indicated that a significant number of BCLC 0/A patients were not initially managed with the curative treatment without knowing why.

Methods: We, therefore, conducted a study on BCLC 0/A patients who had and had not received initial curative treatment cared at our cancer center from January 2011 to December 2015 and analyzed causes contributing to not having the initial curative treatment.

Results: One hundred and sixty-nine BCLC 0/A patients were identified and included in the study. Seventy two patients (43%) received the initial curative treatment and 97 patients (57%) did not. After careful review of medical records, all 97 patients without the initial curative treatment had identifiable reasons for not having the initial curative treatment. Two main reasons for not having the initial curative treatment were "probable presence of additional HCC and requiring diagnostic angiography" (28%) and "difficult or complicating anatomical location of tumors" (17%). When the relevant clinical parameters were compared between the 2 groups of patients, it was found that patients without the initial curative treatment had more serious clinical conditions and worse overall and recurrence-free survival outcomes compared with those who had the initial curative treatment.

Discussion/conclusion: Our finding indicates that a significant fraction of the BCLC 0/A HCC patients is unable to have initial curative treatment as recommended by BCLC guidelines. These early stages of HCC patients represent a distinctive subpopulation and are in need of further investigation to improve their survival outcomes.

Keywords: Barcelona Clinic Liver Cancer staging; Curative treatment; Early stages; Hepatocellular carcinoma; Transcatheter arterial chemoembolization.