Real-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

Abstract

<b><i>Introduction:</i></b> 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). <b><i>Method:</i></b> 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). <b><i>Results:</i></b> 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 <i>p</i> < 0.0001), locally advanced (28.1 vs. 22.2 months <i>p</i> = 0.0216) and locally advanced with macrovascular invasion (10.3 vs. 3.3 months <i>p</i> = 0.0013) but not for metastatic HCC (8.1 vs. 6.8 months <i>p</i> = 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 <i>p</i> = 0.0002; median PFS 6.1 vs. 4.0 months <i>p</i> = 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. <b><i>Conclusion:</i></b> 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.

Real-World Data on the Diagnosis, Treatment, and Management of Hepatocellular Carcinoma in the Asia-Pacific: The INSIGHT Study

“…This preference is consistent with the findings from the Report of the 22nd Nationwide Follow-up Survey of Primary Liver Cancer in Japan (2012–2013, N = 19,209) [53], where 40.3% and 23.9% of the patients received resection and TACE, respectively [53]. In Singapore, there is significant use of radiation therapy for BCLC B (57.4%) and BCLC C (50%) patients as first-line therapy in addition to sorafenib, consistent with the guidelines published in 2021 [15, 54]. Further studies on the extent of the effect of regional guidelines in influencing reimbursement strategies may shed light on the practice patterns reported in this study.…”

“…Most BCLC B patients receive loco-regional treatment like TACE and Y90 (53.6%), but a significant proportion receives surgery (38.5%). Although our data showed that patients who received surgery performed better than those who received loco-regional therapies, the superior mOS observed in Taiwan, Singapore, and Hong Kong could also be attributed to the use of multiple lines of treatment in those countries, which reflects the importance of multidisciplinary care to provide better outcomes for patients [15].…”

Extending surgical resection for hepatocellular carcinoma beyond Barcelona Clinic for Liver Cancer (BCLC) stage A: A novel application of the modified BCLC staging system.

“…This single-centre local experience highlights the importance of integrating personalised medicine and multidisciplinary management to optimise outcomes for a heterogenous disease like HCC. 42 Thus, international guidelines should be contextualised to the local context and to the individual patient.…”

Novel Perspectives towards RNA-Based Nano-Theranostic Approaches for Cancer Management

“…Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and the most common cause of morbidity and mortality [121,122]. A few molecular targeting drugs, such as sorafenib (SO), have been approved for advanced HCC, which also show a peripheral survival chance compared to conventional therapeutics.…”