Adherence to EASL-EORTC clinical guidelines for the management of hepatocellular carcinoma in field practice: Results from the ITALICA database

Introduction: Data on adherence to joint guidelines for the management of hepatocellular carcinoma (HCC) published in 2012 by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) are lacking. Aim: We retrospectively evaluated the adherence to EASLEORTC guidelines in field-practice, using data from HCC patients registered in the Nation-wide Italian database ITA.LI.CA. and diagnosed from 2012. Methods: The ITA.LI.CA. database contains data of 5428 HCC patients treated at 18 Italian Centers. Patients were stratified according to Child-Pugh (CP) and and the Barcelona Clinic Liver Cancer (BCLC) classifications. We investigated the adherence to surveillance, diagnosis, and first-line treatment recommendations. Results: In ITALICA, 600 patients were diagnosed of HCC since 2012 (466 males; mean± SD age 67.4±10.9 years; 277(46.2%) CP-A and 163(27.2%) CP-B; 44(8%) BCLC-0, 193(35.1%) BCLC-A, 93(16.9%) BCLC-B, 172(31.3%) BCLC-C, 48(8.7%) BCLC-D). Overall, 317(55.2%) were diagnosed during a surveillance program. Of them, 231(57.9%) were cirrhotic (median surveillance duration: 6 months). Four-hundred-ninety-six (85.3%, 449 cirrhotic) patients were diagnosed applying a radiological, 80(13.7%) a histological, and6(1%) a cytological criterion. Five (9.7%) patients in BCLC stage 0 with CPA, and single nodules underwent tumour resection; 3(1.4%) patients in BCLC-A received liver transplantation, and 83(43.1%) received radiofrequency ablation or Percutaneous Ethanol Injection. Intermediate HCC-stage patients (BCLC-B) receiving TACE were 45(47.9%), and advanced-stage patients (BCLC-C) receiving sorafenib were 38(21.9%). Palliative care was provided to terminal stage patients (BCLC-D) in 31(64.3%) cases. Conclusions: Theoverall adherence in a “real-world” practice to EASL-EORTC guidelines was low, particularly in patients with early stageHCC. Difficulties inpatients staging and the high prevalence of older patients with relevant co-morbidities may partially explain these findings. Strategies to help improve adherence to international guidelines for HCC in field-practice and new scoring criteria are required.