Establishment of a Multidisciplinary Hepatocellular Carcinoma Clinic is Associated with Improved Clinical Outcome

Abstract

Purpose To evaluate differences in overall survival in patients with hepatocellular carcinoma (HCC) after the establishment of a multidisciplinary clinic (MDC) for HCC. Methods Patient demographic and tumor characteristics of 355 patients diagnosed with HCC were collected between October 2006 and September 2011. Patients diagnosed after the initiation of the HCC MDC on October 1, 2010, were compared to patients diagnosed in the 4 years before. Patient demographics, tumor characteristics, treatment regimens, and overall survival were analyzed between the groups. Results A total of 105 patients were diagnosed in the time period after HCC MDC initiation compared to 250 patients in the previous 4 years. Patients diagnosed with HCC after the HCC MDC had fewer symptoms at presentation (64 vs. 78 %, p = 0.01) and earlier stage of tumor presentation [Barcelona Clinic for Liver Cancer (BCLC) A stage, 44 vs. 26 %, p = 0.0003; tumor, node, metastasis classification system stage 1, 44 vs. 30 %, p = 0.003) compared with patients diagnosed before MDC formation. The median time to treatment after diagnosis in the later period was significantly shorter than in the earlier time period (2.3 vs. 5.3 months, p = 0.002). On multivariate analysis, being seen in the HCC MDC remained independently associated with better overall survival (hazard ratio 2.5, 95 % confidence interval 2–3), after adjusting for BCLC stage and recipient of curative treatment. Patients diagnosed after HCC MDC initiation had a median survival of 13.2 months compared to the 4.8 months observed in patients diagnosed before MDC formation (p = 0.005). Conclusions The implementation of a MDC for the evaluation and treatment of patients with HCC is associated with improved overall survival.

Survival and cost‐effectiveness of sorafenib therapy in advanced hepatocellular carcinoma: An analysis of the SEER–Medicare database

“…These associations may be driven by several factors such as higher rates of multidisciplinary care or better management of liver complications, which have been shown to improve survival (32) ; alternatively, this association may simply represent a referral or selection bias, with healthier patients who have a better prognosis being more likely to seek care at a tertiary care center. Further studies are needed to explore these associations; if confirmed and related to a difference in care delivery, this may suggest that treatment of advanced HCC patients be focused in expert, high-volume centers.…”

Neoangiogenesis-related genes are hallmarks of fast-growing hepatocellular carcinomas and worst survival. Results from a prospective study

“…During the 6-week interval, patients did not undergo any specific treatment. This interval is much shorter than the average time to treatment after HCC diagnosis14 15 and therefore no ethical issues were raised by IRB. After the second CT, patients were treated according to international guidelines1 and were monitored every 3 months unless their clinical condition required more frequent monitoring.…”

Comprehensive Treatment of Advanced Liver Cancer Complicated with Upper Gastrointestinal Bleeding in Multidisciplinary Team Model: A Case Report

“…In another research on evaluating differences in overall survival in patients with HCC after the establishment of a MDT for HCC, a total of 105 patients were diagnosed in the time period after HCC MDT initiation compared to 250 patients in the previous 4 years. The result showed that patients diagnosed after HCC MDT initiation had a median survival of 13.2 months compared to the 4.8 months observed in patients diagnosed before MDT formation [14]. These evidences suggested that the MDT model could benefit patients with HCC.…”