Clinics (Sao Paulo). 2017 August; 72(8): 454-460.

Copyright © 2017 CLINICS

Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage

Luciana Kikuchi * , Aline Lopes Chagas , Regiane S.S.M. Alencar , Claudia Tani , Marcio A. Diniz , Luiz A.C. D’Albuquerque , Flair José Carrilho

São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR

*Corresponding author. E-mail:

received November 8, 2016; revised January 16, 2017; accepted February 24, 2017.



This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease.


This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test.


The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09–0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67–9.88; p<0.001), whereas no differences were observed in patients in stages B or C.


The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.

Keywords: Hepatocellular Carcinoma, Prognosis, Tumor Staging, Guideline Adherence

Articles from Clinics are provided here courtesy of
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

2nd © Copyright 2007 - Revista Clinics - All rights reserved