Adherence to AASLD Recommendation Guideline for
Treatment Hepatocellular Carcinoma: Single Center
Analysis of the Regional Hospital of Thailand
Arunchai Chang MD1, Ritt Utarabhand MD2, Araya Khaimook MD3, Apiradee Songjamrat MD4,
Songklod Pakdeejit MD4, Attapon Rattanasupa MD1
Affiliation :
1 Division of Gastroenterology, Hatyai Hospital, Songkhla, Thailand
2 Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
3 Division of Minimal Invasive Surgery, Hatyai Hospital, Songkhla, Thailand
4 Division of Intervention Radiology, Hatyai Hospital, Songkhla, Thailand
Background : The American Association for Study of Liver Disease (AASLD) Guideline for treatment hepatocellular carcinoma
(HCC) might not be adopted in the real-life practice because of differences in populations characteristics and medical resources
among countries.
Objective : To assess the rate of adherence to AASLD guideline for treatment HCC and the reasons of non-adherence.
Materials and Methods : The 198 cirrhotic patients (cid:976)irst diagnosed HCC in Hatyai Hospital (enrolled between January 2014 and
December 2016) were retrospectively evaluated. Patients were classi(cid:976)ied according to the Barcelona Clinic Liver Cancer (BCLC)
staging system into (cid:976)ive stages, very early stage (BCLC 0), early stage (BCLC A), intermediate stage (BCLC B), advanced stage (BCLC
C), and terminal stage (BCLC D). The rate of adherence to the AASLD guideline for treatment of HCC was evaluated and the reasons
of non-adherence were explored.
Results : Patients were strati(cid:976)ied by the BCLC stages, 10 (5.1%) for BCLC 0, 44 (22.2%) for BCLC A, 61 (30.8%) for BCLC B, 50
(25.3%) for BCLC C, and 33 (16.7%) for BCLC D. Only 123 (62%) patients were found to be adherent to the AASLD guideline. The
rates of adherence to guideline according to BCLC stage 0, A, B, C, and D were 90.0%, 59.1%, 72.1%, 26.0%, and 93.9%, respectively.
Reasons for non-adherence were cost (45.3%), patient opting for best supportive care (29.3%), technical limitation in primary
choice of treatment (12.0%), limited number of liver donors (8.0%), and aggressive treatment recommended by experts (5.3%).
Conclusion : Mainly 62% of the patients diagnosed with HCC for the (cid:976)irst time were treated according to AASLD guideline. Treatment
non-adherence was due to cost, technical limitation, and regional culture background.
Keywords : Hepatocellular carcinoma (HCC), Treatment, Adherence, AASLD, BCLC Thailand
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