Introduction: Barcelona Clinic Liver Cancer (BCLC) staging has been an important clinical guideline for the management of hepatocellular carcinoma (HCC). BCLC 0 and A stages (BCLC 0/A) have been designated as the early-stage HCC, and the curative treatment is recommended as the primary therapeutic modality. However, a recent study indicated that a significant number of BCLC 0/A patients were not initially managed with the curative treatment without knowing why. Methods: We, therefore, conducted a study on BCLC 0/A patients who had and had not received initial curative treatment cared at our cancer center from January 2011 to December 2015 and analyzed causes contributing to not having the initial curative treatment. Results: One hundred and sixty-nine BCLC 0/A patients were identified and included in the study. Seventy two patients (43%) received the initial curative treatment and 97 patients (57%) did not. After careful review of medical records, all 97 patients without the initial curative treatment had identifiable reasons for not having the initial curative treatment. Two main reasons for not having the initial curative treatment were “probable presence of additional HCC and requiring diagnostic angiography” (28%) and “difficult or complicating anatomical location of tumors” (17%). When the relevant clinical parameters were compared between the 2 groups of patients, it was found that patients without the initial curative treatment had more serious clinical conditions and worse overall and recurrence-free survival outcomes compared with those who had the initial curative treatment. Discussion/Conclusion: Our finding indicates that a significant fraction of the BCLC 0/A HCC patients is unable to have initial curative treatment as recommended by BCLC guidelines. These early stages of HCC patients represent a distinctive subpopulation and are in need of further investigation to improve their survival outcomes.
Gastrointest Tumors

中文翻译：

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为什么 BCLC 0 期或 A 期患者不能接受治愈性治疗？

简介：巴塞罗那临床肝癌 (BCLC) 分期一直是肝细胞癌 (HCC) 管理的重要临床指南。BCLC 0 和 A 期（BCLC 0/A）已被指定为早期 HCC，推荐根治性治疗作为主要治疗方式。然而，最近的一项研究表明，大量 BCLC 0/A 患者在不知道原因的情况下最初并未接受治愈性治疗。方法：因此，我们对 2011 年 1 月至 2015 年 12 月在我们癌症中心接受和未接受初始治愈性治疗的 BCLC 0/A 患者进行了研究，并分析了导致未接受初始治愈性治疗的原因。结果：169 名 BCLC 0/A 患者被确定并纳入研究。72 名患者 (43%) 接受了初始治愈性治疗，97 名患者 (57%) 未接受治疗。仔细查阅病历后，97 名未进行初始治疗的患者均有明确的未进行初始治疗的原因。没有进行初始治愈性治疗的两个主要原因是“可能存在额外的 HCC 并需要诊断性血管造影”（28%）和“肿瘤的解剖位置困难或复杂”（17%）。比较两组患者的相关临床参数时，讨论/结论：我们的发现表明，很大一部分 BCLC 0/A HCC 患者无法按照 BCLC 指南的建议进行初始治愈性治疗。这些早期阶段的 HCC 患者代表了一个独特的亚群，需要进一步研究以改善他们的生存结果。
胃肠肿瘤