Bridging the gap between hepatocellular carcinoma management guidelines and personalised medicine: a Bayesian network study.

Abstract

Introduction: There are numerous treatment options available for patients with confirmed hepatocellular carcinoma (HCC). Guidelines such as Barcelona Clinic Liver Cancer (BCLC) support treatment decisions by way of a flow diagram that is organized around groups of patients. Though such guidelines continue to make a major contribution to standardization of treatment, in clinical reality, cases are often more nuanced than is captured in any flow diagram, even one as comprehensive as BCLC. A fundamental challenge for a clinician is to combine such a population-wide guideline with specific information about the individual patient. Bayesian networks (BNs) offer a way to "bridge this gap" and combine standardized care and precision medicine. They do this by enabling answers to detailed "what-if" questions from the clinician.

Methods: We use real-world data of HCC patients who received treatments between 2019 and 2020 to construct a BN to assess the potential treatment effect for cases that were not treated in compliance with BCLC.

Results: We report detailed scenarios for ten randomly selected cases and summarise the difference in survival time for each scenario. For each case, the counterfactual treatment scenarios are made based on whether or not the case is in compliance with BCLC guidelines, the type of treatment received and the waiting time to receive treatment.

Discussion: We consider two cases with similar clinical characteristics (but received different treatments) and discuss whether or not they are treated in compliance to the guidelines resulting in better outcomes than the actual clinical decision. We include a detailed discussion about the assumptions made in constructing the BN and we highlight why such a BN can serve as an AI-based clinical decision support system particularly when there is need for further patient stratification.