Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2023; 29(47): 6122-6137
Published online Dec 21, 2023. doi: 10.3748/wjg.v29.i47.6122
Impact of guideline adherence on the prognosis of Barcelona clinic liver cancer stage B hepatocellular carcinoma
Ji Eun Han, Hyo Jung Cho, Jae Youn Cheong, Sun Gyo Lim, Min Jae Yang, Choong-Kyun Noh, Gil Ho Lee, Soon Sun Kim
Ji Eun Han, Hyo Jung Cho, Jae Youn Cheong, Sun Gyo Lim, Min Jae Yang, Choong-Kyun Noh, Gil Ho Lee, Soon Sun Kim, Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
Author contributions: SS Kim conceived the study and planned the statistical analysis; JE Han and SS Kim conducted statistical analysis; JE Han, SS Kim, HJ Cho, and JY Cheong contributed to the interpretation of the results; JE Han and SS Kim drafted the original manuscript; SS Kim supervised the conduct of the study; All authors reviewed the draft manuscript and revised it critically on intellectual content; All authors approved the final version of the manuscript to be published.
Supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, No. HR21C003000021.
Institutional review board statement: The study was approved by the Institutional Review Board of Ajou University Hospital, Suwon, South Korea (Approval No. AJOUIRB-EX-2023-085).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board of Ajou University Hospital, Suwon, South Korea.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soon Sun Kim, PhD, Professor, Department of Gastroenterology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, South Korea. cocorico99@gmail.com
Received: August 28, 2023
Peer-review started: August 28, 2023
First decision: September 23, 2023
Revised: October 23, 2023
Accepted: December 1, 2023
Article in press: December 1, 2023
Published online: December 21, 2023
Processing time: 112 Days and 17.9 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatocellular carcinoma (HCC) is a major global health concern, and the second leading cause of cancer mortality worldwide. Treatment guidelines are based on the Barcelona Clinic Liver Cancer staging system, but in East Asian countries, liver resection is often preferred to transarterial chemoembolization for stage B HCC due to better survival outcomes.

Research motivation

The need for regional adaptations in HCC treatment guidelines to improve the prognosis of patients with stage B HCC.

Research objectives

This study aims to evaluate adherence to international HCC guidelines in South Korea using data from 2008-2016, investigate the treatment strategies for stage B HCC, analyze the impact of guideline non-adherence on survival, and identify patient subgroups who may benefit from guideline deviation to improve real-world management.

Research methods

In this retrospective analysis, data from the Korea Central Cancer Registry from 2008 to 2016 were utilized. Patients with stage B HCC were categorized into groups based on treatment adherence to HCC guidelines from Asian Pacific, European, and American associations for the study of liver diseases. The primary outcome was HCC-related deaths, with tumor recurrence as a secondary outcome; statistical analysis was performed using Kaplan-Meier curves with log-rank tests and multivariable Cox regression analysis to analyze survival outcomes and predictors.

Research results

The adherence to European Association for the Study of the Liver and American Association for the Study of Liver Diseases HCC treatment guidelines exhibit a declining trend over time in South Korea. Curative treatments, which were a deviation from guideline recommendations, led to significantly improved survival rates. Patients receiving upward treatments were < 70 years of age, and had platelet counts > 105/μL and serum albumin levels ≥ 3.5 g/dL.

Research conclusions

This study, based on real-world data in South Korea, revealed a persistent gap between treatment guideline recommendations and real clinical practice for patients with stage B HCC; liver resection, which was often chosen against guideline recommendations, resulted in improved survival for selected patients.

Research perspectives

These findings suggest that expanding the eligibility criteria for liver resection in specific patient groups may be beneficial. The study also highlights the need for careful patient selection through a multidisciplinary approach when considering curative treatments for stage B HCC. However, prospective studies are needed to further evaluate the clinical implications of curative treatments in stage B HCC.