title: Adherence to AASLD guidelines for the treatment of hepatocellular carcinoma in clinical practice: experience of the Bologna Liver Oncology Group.
abstract: BACKGROUND
  Few data exist on real-life adherence to international guidelines for the treatment of hepatocellular carcinoma. We analysed the rate of adherence to American Association for the Study of Liver Diseases guidelines, to identify reasons for discrepancy with treatments performed in our centre.
  
  
  METHODS
  227 consecutive cirrhotics with a first hepatocellular carcinoma diagnosis (2005-2010) were retrospectively evaluated and stratified based on Barcelona Clinic Liver Cancer system: 126 early, 50 intermediate, 40 advanced, and 11 end stage.
  
  
  RESULTS
  Early hepatocellular carcinomas were theoretically eligible for resection (n=27), liver transplantation (n=36), and percutaneous treatment (n=63). In practice, 15/27 (55.5%), 31/36 (86.1%), and 22/63 (34.9%) respectively were treated as recommended. Reasons for discrepancy were age/comorbidity, tumour location, ultrasound visibility, surgical contraindications. Transarterial chemoembolisation was performed in 25/126 early hepatocellular carcinomas (19.8%), resection in 11/63 early hepatocellular carcinomas eligible for percutaneous treatment (17.5%). Transarterial chemoembolisation was excluded in 16/50 intermediate hepatocellular carcinomas (32%). Resection or transarterial chemoembolisation was performed in 6/40 advanced hepatocellular carcinomas (15%).
  
  
  CONCLUSIONS
  Overall, 60% of patients were treated according to American Association for the Study of Liver Diseases guidelines. Approximately 28% of hepatocellular carcinomas were "under-treated" and 7% treated more aggressively than recommended. Peculiarities of individual patients can lead the multidisciplinary team to personalise real-life treatments.
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: leonisimona@yahoo.it.
authors.forename: Simona
authors.initials: S
authors.lastname: Leoni
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Serio
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Terzi
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Pettinari
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Croci
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Marinelli
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Benevento
authors.affiliation: Division of Radiology, Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D019983:Guideline Adherence; D006498:Hepatectomy; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D000970:Antineoplastic Agents
keywords: Clinical practice; Guidelines applicability; Hepatocellular carcinoma; Personalised treatment