Barcelona Clinic Liver Cancer strategy adherence in hepatocellular carcinoma and its influence on long-term outcomes.

Background: Hepatocellular carcinoma (HCC) survival rates remain poor. This retrospective study evaluated the adherence to the Barcelona Clinic Liver Cancer (BCLC) treatment strategy for HCC in a real-world setting and the effect of deviation from the strategy on long-term outcomes. Methods: We retrospectively analysed all histologically confirmed HCC cases that received invasive treatment at Oulu University Hospital 1986-2022 and Central Finland Central Hospital 1997-2022. Adherence to the BCLC strategy was re-evaluated according to: (I) tumor burden, (II) liver function, (III) patient profile, and (IV) surgical technique. Patients were re-evaluated according to the BCLC strategy of the year of treatment. Results: Among 208 total patients, 93 received surgical treatment, 29 underwent local ablative treatment, and 86 received transarterial treatment. Altogether, 145 (69.7%) patients were treated according to the BCLC strategy. Patients who received surgical treatment according to the BCLC strategy (n=76) had superior survival outcomes than those treated surgically outside the strategy (n=17), with 1-, 3-, and 5-year survival rates of 92.1%, 84.2%, and 78.9%, compared to 82.4%, 41.2%, and 23.5%, respectively (P<0.001). Conclusions: Our findings suggest that adherence to the BCLC strategy is associated with improved survival outcomes in a real-world setting. Patients treated outside the strategy should be carefully selected.