Background: The American Association for Study of Liver Disease (AASLD) Guideline for treatment hepatocellular carcinoma (HCC) might not be adopted in the real-life practice because of differences in populations characteristics and medical resources among countries.

Objective: To assess the rate of adherence to AASLD guideline for treatment HCC and the reasons of non-adherence.

Materials and Methods: The 198 cirrhotic patients first diagnosed HCC in Hatyai Hospital (enrolled between January 2014 and December 2016) were retrospectively evaluated. Patients were classified according to the Barcelona Clinic Liver Cancer (BCLC) staging system into five stages, very early stage (BCLC 0), early stage (BCLC A), intermediate stage (BCLC B), advanced stage (BCLC C), and terminal stage (BCLC D). The rate of adherence to the AASLD guideline for treatment of HCC was evaluated and the reasons of non-adherence were explored.

Results: Patients were stratified by the BCLC stages, 10 (5.1%) for BCLC 0, 44 (22.2%) for BCLC A, 61 (30.8%) for BCLC B, 50 (25.3%) for BCLC C, and 33 (16.7%) for BCLC D. Only 123 (62%) patients were found to be adherent to the AASLD guideline. The rates of adherence to guideline according to BCLC stage 0, A, B, C, and D were 90.0%, 59.1%, 72.1%, 26.0%, and 93.9%, respectively. Reasons for non-adherence were cost (45.3%), patient opting for best supportive care (29.3%), technical limitation in primary choice of treatment (12.0%), limited number of liver donors (8.0%), and aggressive treatment recommended by experts (5.3%).

Conclusion: Mainly 62% of the patients diagnosed with HCC for the first time were treated according to AASLD guideline. Treatment non-adherence was due to cost, technical limitation, and regional culture background.

Keywords: Hepatocellular carcinoma (HCC), Treatment, Adherence, AASLD, BCLC Thailand