Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges

Table 1 Surveillance for hepatocellular carcinoma in Latin America

Study	Population	Design	Results
Fassio et al[8]	n = 240 HCC Brazil, Arg, Colombia, Chile, Uruguay, Venezuela	Prospective cohort (Surveillance retrospectively analyzed)	54% under surveillance; BCLC A 70% vs 39% not under surveillance; No survival analysis
Paranaguá-Vezozzo et al[9]	n = 884 Cirrhosis Child A-B Brazil, Sao Paulo	Retrospective cohort US ± AFP annual	HCC annual incidence 2.9%; 75% under annual surveillance; 80% within Milan, better survival
Piñero et al[10]	n = 643 Cirrhosis, waiting list for liver transplantation. Argentina	Retrospective cohort Surveillance Failure = incidental HCC in the explant	US accuracy: S 33% and E 99%
Campos Appel-da-Silva et al[11]	n = 453 Child A-C Cirrhosis Brazil, Porto Alegre	Retrospective cohort US ± AFP every 6 mo	50.7% under surveillance; More BCLC 0-A vs no screening; Better survival within Milan criteria
Debes et al[12]	n = 1336 HCC Brazil, Argentina, Colombia, Peru, Uruguay, Ecuador	Retrospective cohort	47% under surveillance; Better survival vs symptomatic diagnosis (adjusted for lead-time bias)

BCLC: Barcelona Clinic Liver Cancer; HCC: Hepatocellular carcinoma; US: Ultrasound.

Table 2 Adherence to clinical practice guidelines around the world and in Latin America

Study	Population	Design	Results
Leoni et al[20]	n = 227 HCV 58% Child A 54%	Retrospective cohort (2005-2010) One center	At HCC diagnosis: BCLC 0-A 55%; Adherence to BCLC 60%; Higher adherence among BCLC A 86%
Gashin et al[21]	n = 137 HCV 62%	Retrospective cohort (2009-2010) One center	Adherence to BCLC 62%; Better overall survival; Heterogeneous causes of non-adherence
Kim et al[22]	n = 3515 HBV 77% Child A 82%	Retrospective cohort (2005-2009) One center	At HCC diagnosis: BCLC A 59%; Adherence to BCLC 49%; Better survival for adherence, except BCLC-D (BCLC D who were transplanted were considered “non-adherence”)
Wallace et al[23]	n = 292 OH-HCV 65%	Retrospective cohort (2006-2014) One center	At HCC diagnosis: BCLC 0-A 64%; Adherence to BCLC 48% vs HKLC 56% (P.001); No better survival among BCLC adherence vs no-adherence but better survival among HKLC (TACE before transplant was considered “no-adherence”)
Guarino et al[24]	n = 1008 HCV Child A 73%	Retrospective cohort (2013-2015) Multicenter study	At HCC diagnosis: BCLC 0-A 59%; Adherence BCLC 71%, lower in BCLC B 36% and C 46%; No better survival (TACE before transplant was considered “no-adherence”)
Kikuchi et al[25]	n = 364 HBV 53% Child A 53%	Retrospective cohort (2010-2012) One center	At HCC diagnosis: BCLC A 36%; Adherence BCLC 52%; Lower adherence in BCLC C-D; No better survival, except in BCLC A (BCLC D who were transplanted were considered “non-adherence”)
Piñero et al[26]	n = 708 HCV 58% Child A 54%	Dual cohort (2009-2016) Multicenter study	At HCC diagnosis: BCLC 0-A 47%; Adherence BCLC 53% initial, 63% subsequently; Adherence to BCLC: better survival HR 0.67 (CI: 0.52-0.87)

BCLC: Barcelona Clinic Liver Cancer; HKLC: Hong Kong Liver Cancer algorithm; HCV: Hepatitis C virus; HBV: Hepatitis B virus; TACE: Transarterial chemoembolization.