title: Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm.
abstract: OBJECTIVE
  The Barcelona Clinic Liver Cancer (BCLC) staging system is the algorithm most widely used to manage patients with hepatocellular carcinoma (HCC). We aimed to investigate the extent to which the BCLC recommendations effectively guide clinical practice and assess the reasons for any deviation from the recommendations.
  
  
  METHODS
  The first-line treatments assigned to patients included in the prospective Bern HCC cohort were analyzed.
  
  
  RESULTS
  Among 223 patients included in the cohort, 116 were not treated according to the BCLC algorithm. Eighty percent of the patients in BCLC stage 0 (very early HCC) and 60% of the patients in BCLC stage A (early HCC) received recommended curative treatment. Only 29% of the BCLC stage B patients (intermediate HCC) and 33% of the BCLC stage C patients (advanced HCC) were treated according to the algorithm. Eighty-nine percent of the BCLC stage D patients (terminal HCC) were treated with best supportive care, as recommended. In 98 patients (44%) the performance status was disregarded in the stage assignment.
  
  
  CONCLUSIONS
  The management of HCC in clinical practice frequently deviates from the BCLC recommendations. Most of the curative therapy options, which have well-defined selection criteria, were allocated according to the recommendations, while the majority of the palliative therapy options were assigned to patients with tumor stages not aligned with the recommendations. The only parameter which is subjective in the algorithm, the performance status, is also the least respected.
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern. Switzerland.
authors.forename: Mandy
authors.initials: M
authors.lastname: Richani
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern. Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Kolly
authors.affiliation: University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern. Switzerland.
authors.forename: Marina
authors.initials: M
authors.lastname: Knoepfli
authors.affiliation: University Clinic for Radio-oncology, Inselspital, University of Bern. Switzerland.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Oncology, Inselspital, University of Bern. Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Zweifel
authors.affiliation: University Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern. Switzerland.
authors.forename: Hendrik
authors.initials: H
authors.lastname: von Tengg-Kobligk
authors.affiliation: University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern. Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern. Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000592:standards*; D019983:Guideline Adherence; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D009367:Neoplasm Staging / Q000379:methods* / Q000592:standards; D010166:Palliative Care; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents