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
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 t...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2021-04-01
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| Series: | Liver Cancer |
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| Online Access: | https://www.karger.com/Article/FullText/514400 |
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| author | Xin Hui Chew Rehena Sultana Eshani N. Mathew David Chee Eng Ng Richard H.G. Lo Han Chong Toh David Tai Su Pin Choo Brian Kim Poh Goh Sean Xuexian Yan Kelvin Siu Hoong Loke Sue Ping Thang Apoorva Gogna Nanda Karaddi Venkatanarasimha Aaron K.T. Tong Fiona N.N. Moe Jacelyn S.S. Chua Reiko W.T. Ang Aldwin D. Ong Ashley W.Y. Ng Marjorie T.Q. Hoang Chow Wei Too Choon Hua Thng Wan Ying Chan Wanyi Kee Jaclyn H. M. Chan Farah Irani Sum Leong Kiat Hon Lim Michael L.C. Wang Pierce K.H. Chow |
| author_facet | Xin Hui Chew Rehena Sultana Eshani N. Mathew David Chee Eng Ng Richard H.G. Lo Han Chong Toh David Tai Su Pin Choo Brian Kim Poh Goh Sean Xuexian Yan Kelvin Siu Hoong Loke Sue Ping Thang Apoorva Gogna Nanda Karaddi Venkatanarasimha Aaron K.T. Tong Fiona N.N. Moe Jacelyn S.S. Chua Reiko W.T. Ang Aldwin D. Ong Ashley W.Y. Ng Marjorie T.Q. Hoang Chow Wei Too Choon Hua Thng Wan Ying Chan Wanyi Kee Jaclyn H. M. Chan Farah Irani Sum Leong Kiat Hon Lim Michael L.C. Wang Pierce K.H. Chow |
| author_sort | Xin Hui Chew |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T07:37:52Z |
| format | Article |
| id | doaj.art-2304dc56246c48ac829e27e6772fcefd |
| institution | Directory Open Access Journal |
| issn | 2235-1795 1664-5553 |
| language | English |
| last_indexed | 2024-12-17T07:37:52Z |
| publishDate | 2021-04-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Liver Cancer |
| spelling | doaj.art-2304dc56246c48ac829e27e6772fcefd2022-12-21T21:58:16ZengKarger PublishersLiver Cancer2235-17951664-55532021-04-0111610.1159/000514400514400Real-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 CarcinomaXin Hui Chew0Rehena Sultana1Eshani N. Mathew2David Chee Eng Ng3Richard H.G. Lo4Han Chong Toh5David Tai6Su Pin Choo7https://orcid.org/0000-0002-8925-3922Brian Kim Poh Goh8Sean Xuexian Yan9Kelvin Siu Hoong Loke10Sue Ping Thang11Apoorva Gogna12Nanda Karaddi Venkatanarasimha13Aaron K.T. Tong14Fiona N.N. Moe15Jacelyn S.S. Chua16Reiko W.T. Ang17Aldwin D. Ong18Ashley W.Y. Ng19Marjorie T.Q. Hoang20Chow Wei Too21Choon Hua Thng22Wan Ying Chan23Wanyi Kee24Jaclyn H. M. Chan25Farah Irani26Sum Leong27Kiat Hon Lim28Michael L.C. Wang29Pierce K.H. Chow30Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeCenter of Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore, SingaporeDepartment of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, SingaporeDivision of Medical Oncology, National Cancer Centre Singapore, Singapore, SingaporeDivision of Medical Oncology, National Cancer Centre Singapore, Singapore, SingaporeDivision of Medical Oncology, National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore, SingaporeDepartment of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore, SingaporeDepartment of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore, SingaporeDepartment of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, SingaporeDepartment of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, SingaporeDepartment of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, SingaporeDivision of Oncologic Imaging, National Cancer Centre Singapore, Singapore, SingaporeDivision of Oncologic Imaging, National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeDepartment of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, SingaporeDepartment of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, SingaporeDepartment of Anatomical Pathology, Singapore General Hospital, Singapore, SingaporeDepartment of Radiation Oncology, National Cancer Centre, Singapore, SingaporeDepartment of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, SingaporeIntroduction: 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.https://www.karger.com/Article/FullText/514400real-world datahepatocellular carcinomapractice guidelinesliver cancer |
| spellingShingle | Xin Hui Chew Rehena Sultana Eshani N. Mathew David Chee Eng Ng Richard H.G. Lo Han Chong Toh David Tai Su Pin Choo Brian Kim Poh Goh Sean Xuexian Yan Kelvin Siu Hoong Loke Sue Ping Thang Apoorva Gogna Nanda Karaddi Venkatanarasimha Aaron K.T. Tong Fiona N.N. Moe Jacelyn S.S. Chua Reiko W.T. Ang Aldwin D. Ong Ashley W.Y. Ng Marjorie T.Q. Hoang Chow Wei Too Choon Hua Thng Wan Ying Chan Wanyi Kee Jaclyn H. M. Chan Farah Irani Sum Leong Kiat Hon Lim Michael L.C. Wang Pierce K.H. Chow 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 Liver Cancer real-world data hepatocellular carcinoma practice guidelines liver cancer |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | real-world data hepatocellular carcinoma practice guidelines liver cancer |
| url | https://www.karger.com/Article/FullText/514400 |
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