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28 October 2016 : Original article  

Assigning Treatment to HCC Patients for Transplantation: Utility of a New Decision-Making Tool

Najmul Hassan ShahABDEF, Faisal Saud DarADEF, Abu Bakar Hafeez BhattiABCDEF, Atif RanaACDE, Mohammad SalihDEF

DOI: 10.12659/AOT.899715

Ann Transplant 2016; 21:668-674

Abstract

BACKGROUND: The Barcelona clinic liver cancer (BCLC) staging system is considered the standard of care for hepatocellular carcinoma (HCC) management. It has various limitations, including lack of second-line treatment options and combination therapy. We prospectively collected data on our HCC patients based on a new decision-making tool (NDT). The objective of this study was to determine the applicability of this tool and compare it with BCLC for treatment allocation, in particular with respect to liver transplantation.

MATERIAL AND METHODS: We retrospectively reviewed HCC patients who were managed based on an NDT that was developed in 2012. All patients whose treatment decision was based on this tool between 2012 and 2015 were included. Comparison was made with BCLC. Survival was compared for patients who underwent liver transplantation.

RESULTS: Based on the NDT, 406 (40.6%) patients were eligible for curative treatment versus only 22 (2.2%) patients based on BCLC. A total of 58 (5.8%) patients underwent liver transplant based on the NDT, while only 2 (0.2%) were transplantable based on BCLC. Estimated 3-year survival for transplanted patients based on the NDT was 73%. There were 41 (4.1%) stage C and 15 (1.5%) stage D BCLC patients who received transplant based on the NDT. Estimated 3-year survival for stage A, C, and D BCLC patients who received transplantation was 100%,72%, and 67%, respectively (P=0.6).

CONCLUSIONS: The NDT correctly identified a group of HCC patients for liver transplantation who would otherwise have received palliative treatment based on the BCLC algorithm.

Keywords: Transplantation, Outcome Assessment (Health Care)

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358