Background: The American Association for the Study of Liver Disease (AASLD) guidelines outline an algorithm regarding the treatment modality of choice for patients with hepatocellular carcinoma (HCC) based on Barcelona Clinic Liver Cancer (BCLC) stage. The AASLD guidelines have several limitations and the adherence rate has been reported to be low. The adherence to AASLD guidelines in treating patients with HCC was explored in this study. Methods: Between 2017 and 2019, 106 patients with HCC were identified. In our cohort, 70 patients (66%) were discussed in the multidisciplinary tumor board (MDTB) and their first-line treatment modality was selected based on consensus recommendations from the MDTB team members. The adherence rate of MDTB recommendations to AASLD guidelines was calculated. Results: Median age was 65 (range 42-90). Males represented 84% while females represented 16%. Caucasians, African Americans and Asians represented 69%, 30% and 1% respectively. BCLC stage 0, A, B, C and D represented 7%, 32%, 23%, 27% and 11% respectively. First-line treatment modality of choice recommended by MDTB is summarized in Table. The overall adherence rate of MDTB recommendations to AASLD guidelines is 60%. For BCLC stage 0, A, B, C and D, the adherence rate was 60%, 86%, 44%,58% and 25% respectively. Conclusions: Our MDTB recommendations adherence rate to AASLD guidelines was 60%. The reported low adherence rate to the guidelines suggest that AASLD guidelines would benefit from further refinement and periodic update.

Treatment modalities for patients with HCC. TACE: transarterial chemoembolization; SBRT: stereotactic body radiotherapy; OLT: orthotopic liver transplant; BSC: best supportive care.