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. 2021 Jun;10(3):224-239.
doi: 10.1159/000514400. Epub 2021 Apr 7.

Real-World Data on Clinical Outcomes of Patients with Liver Cancer: A Prospective Validation of the National Cancer Centre Singapore Consensus Guidelines for the Management of Hepatocellular Carcinoma

Xin Hui Chew  1   2 , Rehena Sultana  3 , Eshani N Mathew  1 , David Chee Eng Ng  4 , Richard H G Lo  5 , Han Chong Toh  6 , David Tai  6 , Su Pin Choo  6 , Brian Kim Poh Goh  1 , Sean Xuexian Yan  4 , Kelvin Siu Hoong Loke  4 , Sue Ping Thang  4 , Apoorva Gogna  5 , Nanda Karaddi Venkatanarasimha  5 , Aaron K T Tong  4 , Fiona N N Moe  1 , Jacelyn S S Chua  1 , Reiko W T Ang  1 , Aldwin D Ong  1 , Ashley W Y Ng  1 , Marjorie T Q Hoang  1 , Chow Wei Too  5 , Choon Hua Thng  7 , Wan Ying Chan  7 , Wanyi Kee  1 , Jaclyn H M Chan  1 , Farah Irani  5 , Sum Leong  5 , Kiat Hon Lim  8 , Michael L C Wang  9 , Pierce K H Chow  1   10
Affiliations

Real-World Data on Clinical Outcomes of Patients with Liver Cancer: A Prospective Validation of the National Cancer Centre Singapore Consensus Guidelines for the Management of Hepatocellular Carcinoma

Xin Hui Chew et al. Liver Cancer. 2021 Jun.

Abstract

Introduction: Real-world management of patients with hepatocellular carcinoma (HCC) is crucially challenging in the current rapidly evolving clinical environment which includes the need for respecting patient preferences and autonomy. In this context, regional/national treatment guidelines nuanced to local demographics have increasing importance in guiding disease management. We report here real-world data on clinical outcomes in HCC from a validation of the Consensus Guidelines for HCC at the National Cancer Centre Singapore (NCCS).

Method: We evaluated the NCCS guidelines using prospectively collected real-world data, comparing the efficacy of treatment received using overall survival (OS) and progression-free survival (PFS). Treatment outcomes were also independently evaluated against 2 external sets of guidelines, the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC).

Results: Overall treatment compliance to the NCCS guidelines was 79.2%. Superior median OS was observed in patients receiving treatment compliant with NCCS guidelines for early (nonestimable vs. 23.5 months p < 0.0001), locally advanced (28.1 vs. 22.2 months p = 0.0216) and locally advanced with macrovascular invasion (10.3 vs. 3.3 months p = 0.0013) but not for metastatic HCC (8.1 vs. 6.8 months p = 0.6300), but PFS was similar. Better clinical outcomes were seen in BCLC C patients who received treatment compliant with NCCS guidelines than in patients with treatment only allowed by BCLC guidelines (median OS 14.2 vs. 7.4 months p = 0.0002; median PFS 6.1 vs. 4.0 months p = 0.0286). Clinical outcomes were, however, similar for patients across all HKLC stages receiving NCCS-recommended treatment regardless of whether their treatment was allowed by HKLC.

Conclusion: The high overall compliance rate and satisfactory clinical outcomes of patients managed according to the NCCS guidelines confirm its validity. This validation using real-world data considers patient and treating clinician preferences, thus providing a realistic analysis of the usefulness of the NCCS guidelines when applied in the clinics.

Keywords: Hepatocellular carcinoma; Liver cancer; Practice guidelines; Real-world data.

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Conflict of interest statement

Pierce K.H. Chow declares the following conflicts of interest: Editorial Board Member of Liver Cancer, Consulting or Advisory Role: Sirtex Medical, Bayer, Roche, New B Innovation, MSD, BTG PLC, Eisai, Abbott, IQVIA, Genentech, L.E.K Consulting, Astra Zeneca, Guerbet, Ipsen, OncoSil Medical, and Bristol-Myers Squibb; Speakers' Bureau: Sirtex Medical; and Research Funding: Sirtex Medical (Inst), New B Innovation (Inst), and IQVIA (Inst).

Figures

Fig. 1
Fig. 1
HCC staging system based on the NCCS consensus guidelines (retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906434/). NCCS, National Cancer Centre Singapore; HCC, hepatocellular carcinoma.
Fig. 2
Fig. 2
NCCS consensus guidelines (retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906434/). NCCS, National Cancer Centre Singapore.
Fig. 3
Fig. 3
Study CONSORT diagram.
Fig. 4
Fig. 4
KM plot comparing OS between NCCS treatment compliant groups within each HCC stage. OS, overall survival; KM, Kaplan-Meier; HCC, hepatocellular carcinoma; VI, vascular invasion.
Fig. 5
Fig. 5
KM curves comparing PFS between NCCS treatment compliant groups within each HCC stage. NCCS, National Cancer Centre Singapore; PFS, progression-free survival; KM, Kaplan-Meier; HCC, hepatocellular carcinoma; VI, vascular invasion.
Fig. 6
Fig. 6
Performance assessment of the NCCS consensus guidelines (locally advanced HCC). NCCS, National Cancer Centre Singapore; HCC, hepatocellular carcinoma.
See this image and copyright information in PMC

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