The impact of adherence to NCCN and BCLC treatment guidelines on survival in HCC: A single center study.

561 Background: Hepatocellular carcinoma (HCC) is a prevalent and lethal disease in Saudi Arabia, and globally. Guidelines such as Barcelona Clinic Liver Cancer (BCLC) and National Comprehensive Cancer Network (NCCN) are used to guide therapy for this disease. Adherence to these guidelines should lead to better outcomes. We aim to examine the adherence to guidelines and its impact on survival in a real world setting. Methods: This retrospective cross-sectional study was conducted at the Ministry of National Guard for Health Affairs, Riyadh, Saudi Arabia. Study included all adult patients with HCC who were diagnosed between 2020 and 2023, and presented at our HCC multidisciplinary tumor board (MDT). Data extracted included demographics, clinical and disease characteristics, treatment modalities, and survival status. Chi-square tests, and Kaplan-Meier survival analysis were used to explore relationships between tumor characteristics, adherence to NCCN and BCLC guidelines, and survival outcomes. Adherence to guidelines were assessed by two independent physicians. Results: The study included 208 patients with HCC, the majority were males (73%) with a mean age of 73 years. Less than half of the patients (41.7%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 1. Tumor staging showed that 35% of the patients had BCLC stage D. Child pugh class A and B were equally present in 45% of the patients. Moreover, 24% of the patients had distant metastases or vascular invasion (in portal vein) placing them in BCLC stage C. It is noteworthy that Alpha-Fetoprotein (AFP) was abnormal (>8ng/ml) in 58% of the patients, 18% of them had AFP of more than 400ng/ml. Additionally, the prevalence of comorbid conditions were remarkable for liver cirrhosis being present in 85% of patients, while diabetes mellitus and hypertension each present in 63% of patients. Finally, survival analysis showed a median survival of 16.8 months in all patients with HCC (range 0-47.8 months). Adherence to guidelines were high, with 97.6% (n=203) following NCCN guidelines and 70.7% (n=147) following BCLC guidelines. Following both guidelines showed better survival with mean of 37 months (SD=1.841) in patients with child pugh class A (n=53), and mean survival of 24 months (SD=2.251) in patients with child pugh class B (n=74). Conclusions: Adherence to NCCN guidelines was high in our MDT presented patients compared to BCLC guidelines adherence which was lower, but with comparable survival outcomes.