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

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 indi

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association

“… 12 - 16 Although curative treatments are primarily recommended for early HCC, TACE can be an alternative treatment when curative treatments cannot be conducted considering patients’ liver function, performance status, underlying diseases, portal hypertension, tumor location, or tumor visibility on ultrasonography. 17 In Eastern guidelines, TACE is also performed in HCC with vascular invasion, which may have a survival benefit when it is conducted for selected patients with locally advanced HCC and preserved liver function. 12 - 15 , 18 …”

Transarterial chemoembolization for hepatocellular carcinoma: 2023 Expert consensus-based practical recommendations of the Korean Liver Cancer Association

“…In the international guidelines, including the 2022 KLCA-National Cancer Center (NCC) Korea practice guidelines for the management of HCC, TACE is recommended as the first-line treatment for patients with preserved liver function, good performance status, and no radiologic evidence of vascular invasion and extrahepatic spread when surgical resection, transplantation, or ablation are not viable options [ 12 - 16 ]. Although curative treatments are primarily recommended for early HCC, TACE can be an alternative treatment when curative treatments cannot be conducted considering patients’ liver function, performance status, underlying diseases, portal hypertension, tumor location, or tumor visibility on ultrasonography [ 17 ]. In Eastern guidelines, TACE is also performed in HCC with vascular invasion, which may have a survival benefit when it is conducted for selected patients with locally advanced HCC and preserved liver function [ 12 - 15 , 18 ].…”

“…[12][13][14][15][16] Although curative treatments are primarily recommended for early HCC, TACE can be an alternative treatment when curative treatments cannot be conducted considering patients' liver function, performance status, underlying diseases, portal hypertension, tumor location, or tumor visibility on ultrasonography. 17 In Eastern guidelines, TACE is also performed in HCC with vascular invasion, which may have a survival benefit when it is conducted for selected patients with locally advanced HCC and preserved liver function. [12][13][14][15]18 Unlike systemic treatments, the amount of chemotherapeutic agents and extent of treatment depend on tumor size, location, and distribution, which affects liver function as well as tumor responses.…”

Transarterial Chemoembolization for Hepatocellular Carcinoma: 2023 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association

“…In the international guidelines, including the 2022 KLCA-National Cancer Center (NCC) Korea practice guidelines for the management of HCC, TACE is recommended as the first-line treatment for patients with preserved liver function, good performance status, and no radiologic evidence of vascular invasion and extrahepatic spread when surgical resection, transplantation, or ablation are not viable options [ 12 13 14 15 16 ]. Although curative treatments are primarily recommended for early HCC, TACE can be an alternative treatment when curative treatments cannot be conducted considering patients’ liver function, performance status, underlying diseases, portal hypertension, tumor location, or tumor visibility on ultrasonography [ 17 ]. In Eastern guidelines, TACE is also performed in HCC with vascular invasion, which may have a survival benefit when it is conducted for selected patients with locally advanced HCC and preserved liver function [ 12 13 14 15 18 ].…”