BRIDGING THE GAP IN HCC CARE: FIRST REAL-WORLD ANALYSIS OF BCLC ADHERENCE AND SURVIVAL IN A CENTRAL AMERICAN POPULATION

Introduction and Objectives

Hepatocellular carcinoma (HCC) is a major global health burden. The Barcelona Clinic Liver Cancer (BCLC) staging system provides evidence-based treatment guidance, but real-world adherence remains limited, particularly in Latin America.

Assess adherence to the 2022 BCLC first-line treatment recommendations and their impact on survival in a prospective cohort from a liver transplant (LT) center.

Materials and Methods

Prospective cohort study included 260 adults diagnosed with HCC between 2018 and 2024. Adherence was defined as receipt of first-line therapy consistent with BCLC stage. Multivariate logistic regression identified predictors of adherence, and Kaplan-Meier analysis evaluated survival outcomes.

Results

Overall adherence to BCLC was 47.8%, with substantial variability by stage: 44.9% in BCLC 0/A, 53.7% in B, 23.1% in C, and 93.5% in D (p < 0.001). Only 26.3% of patients received potentially curative therapy. Among 53 LT-eligible patients, 45% underwent transplantation, while 30.2% progressed or died before listing. Logistic regression identified Child-Pugh class B/C (aOR: 3.82; p < 0.001) and ECOG > 0 (aOR: 5.04; p = 0.022) as independent predictors of adherence, while BCLC stages B, C, and D exhibited a strong inverse association. Adherence proved significantly prolonged median overall survival (722 vs. 535 days; p = 0.001), with marked benefit in stages 0/A (1,404 vs. 807 days; p = 0.005) and C (492 vs. 168 days; p = 0.029).

Conclusions

Adherence to BCLC treatment significantly improves survival, yet remains suboptimal—particularly in intermediate stages. This highlights the need for tailored strategies to improve implementation and equity in HCC care in resource-limited settings.

Conflict of interest: None

Kaplan-Meier survival curves comparing adherent and non-adherent patients stratified by BCLC stage.