Abstracts of the 2023 Annual Meeting of the ALEH
More infoHepatocellular carcinoma (HCC) is a major problem in Latin America, but international guidelines do not consider the sociocultural heterogeneity and economic disparities in the region. We review the multidisciplinary approach and results from the largest cohort to date reporting on HCC in Central America.
Materials and MethodsRetrospective analysis of a cohort of HCC diagnosed radiographically or histologically and analysis of the multidisciplinary approach.
Resultsfrom 10/2018 to 03/2023, 186 cirrhotic patients with HCC were evaluated. Distribution according to BCLC staging system was: 3, 46, 17, 22, and 12% for stage 0 to D, respectively. As initial treatment, most patients received transarterial therapy (TA) (n=79, 43%) followed by ablation (n=29, 16%), systemic treatment (ST) (n=11, 6%), surgical resection (n=9, 5%) and liver transplantation (LT) without bridging therapy (n=3, 2%). Based on current EASL guidelines, 49% of patients received a BCLC-recommended treatment strategy and 51% had a stage migration strategy based on multidisciplinary decisions: 0: 33% TA, A: 59% TA, B: 31% ST, C: 61% palliative and 17% TA. Main reasons for migration strategy were the location of the lesion (0/A to TA), risk factors for decompensation after TA (B to ST) and limited access to ST. Using selected criteria (<65 years, San Francisco criteria and no apparent contraindications), 21% (n=39) were candidates for LT: 38% (n=15) progressed or died outside the LT list (LTL), 10% (n=4) were managed with another treatment and remain off LTL, 26% receive LT (n=10) and 3% (n=1) drop out or die on LTL. Main reason for LT rate among candidates is low availability of donors and waiting time on list (mean rate 2018-2022: 5.72DD/pmp/y, mean waiting time: 236 days).
Conclusionsfactors such as availability of resources and local experience frequently lead to multidisciplinary approaches adapted to health system and divergent from the established guidelines.
