Treatment allocation in XXXX : Assessment of the BCLC algorithm.

@entity1 @entity157 @entity5 @entity96
BACKGROUND AND AIMS: The Barcelona Clinic @entity96 (BCLC) staging system is the algorithm most widely used to manage @entity1 with @entity157 ( @entity157 ). We aimed to investigate the extent to which the BCLC recommendations effectively guide clinical practice and assess the reasons for any deviation from the recommendations. MATERIAL AND METHODS: The first-line treatments assigned to @entity1 included in the prospective Bern @entity157 cohort were analyzed. RESULTS: Among 223 @entity1 included in the cohort, 116 were not treated according to the BCLC algorithm. Eighty percent of the @entity1 in BCLC stage 0 (very early @entity157 ) and 60% of the @entity1 in BCLC stage A (early @entity157 ) received recommended curative treatment. Only 29% of the BCLC stage B @entity1 (intermediate @entity157 ) and 33% of the BCLC stage C @entity1 (advanced @entity157 ) were treated according to the algorithm. Eighty-nine percent of the BCLC stage D @entity1 (terminal @entity157 ) were treated with best supportive care, as recommended. In 98 @entity1 (44%) the performance status was disregarded in the stage assignment. CONCLUSION: The management of @entity157 in clinical practice frequently deviates from the BCLC recommendations. Most of the curative therapy options, which have well-defined selection criteria, were allocated according to the recommendations, while the majority of the palliative therapy options were assigned to @entity1 with @entity5 stages not aligned with the recommendations. The only parameter which is subjective in the algorithm, the performance status, is also the least respected.
