title: Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy.
abstract: BACKGROUND
  Real life management of hepatocellular carcinoma occasionally deviates from guidelines for recommended therapy.
  
  
  OBJECTIVE
  To evaluate how frequent this deviation happens in our center and assess its impact on outcome.
  
  
  METHODS
  The treatment of 770 patients (87% males, mean age 57.8 years) was analyzed and the effect of deviation on outcome over 36 months was examined.
  
  
  RESULTS
  Of Barcelona Clinic liver cancer stages 0 and A patients, 65.8% received resection, ablation, liver transplantation or transarterial chemoembolisation for unresectable tumors more than 5 cm in diameter, and 34.2% received treatment recommended for later stages. Of stage B patients, 62.2% received recommended therapy, 34.3% of patients received supportive therapy or sorafenib and 3.5% received upward treatment stage migration. Among stage C patients, 7.6% received sorafenib, and most (79.2%) were given supportive care. Deviation from recommended therapy occurred in 34.2%, 37.7%, and 92.4% in stages 0-A, B and C. Survival of stage 0-A patients who received downwards treatment stage migration was lower than those who received recommended treatment (p <0.001). Upward treatment stage migration in stages B, C and D did not improve survival compared to those who received recommended treatment.
  
  
  CONCLUSIONS
  Deviation from recommended therapy had a negative impact on survival in Barcelona Clinic liver cancer stage A patients.
authors.affiliation: Oncology, National Liver Institute, Menoufiya University, Shebeen ElKom, Egypt E-mail : iwaked@liver-eg.org.
authors.forename: Alzhraa
authors.initials: A
authors.lastname: Alkhatib
authors.forename: Asmaa
authors.initials: A
authors.lastname: Gomaa
authors.forename: Naglaa
authors.initials: N
authors.lastname: Allam
authors.forename: Eman
authors.initials: E
authors.lastname: Rewisha
authors.forename: Imam
authors.initials: I
authors.lastname: Waked
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D004534:Egypt; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib