Multidisciplinary care for patients with HCC: a systematic review and meta-analysis

Dahan, Karim Seif El; Reczek, Annika; Daher, Darine; Rich, Nicole E.; Yang, Ju Dong; Hsiehchen, David; Zhu, Hao; Patel, Madhukar S.; Molano, Maria del Pilar Bayona; Sanford, Nina N.; Gopal, Purva; Parikh, Neehar D.; Yopp, Adam C.; Singal, Amit G.

doi:10.1097/hc9.0000000000000143

Cited by 23 publications

(12 citation statements)

References 47 publications

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“…These data reinforce that screening is only the first step in the cancer care continuum, and patients with early-stage detection must undergo timely curative treatment to have improved survival . Efforts are needed to promote patients receiving high-quality care at multidisciplinary, high-volume settings to reduce issues regarding underuse of curative treatments …”

Section: Discussionmentioning

confidence: 89%

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Hepatocellular Carcinoma Screening in a Contemporary Cohort of At-Risk Patients

Daher,

Seif El Dahan,

Rich

et al. 2024

JAMA Netw Open

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ImportanceCohort studies demonstrating an association of hepatocellular carcinoma (HCC) screening with reduced mortality are prone to lead-time and length-time biases.ObjectiveTo characterize the clinical benefits of HCC screening, adjusting for lead-time and length-time biases, in a diverse, contemporary cohort of at-risk patients.Design, Setting, and ParticipantsThis retrospective cohort study of patients with HCC was conducted between January 2008 and December 2022 at 2 large US health systems. Data analysis was performed from September to November 2023.Main Outcomes and MeasuresThe primary outcome was screen-detected HCC, defined by abnormal screening-intent abdominal imaging or α-fetoprotein level within 6 months before diagnosis. Cox regression analysis was used to characterize differences in overall survival between patients with screen-detected and non–screen-detected HCC; lead-time and length-time adjustments were calculated using the Duffy parametric formula.ResultsAmong 1313 patients with HCC (mean [SD] age, 61.7 [9.6] years; 993 male [75.6%]; 739 [56.3%] with Barcelona Clinic Liver Cancer stage 0/A disease), HCC was screen-detected in 556 (42.3%) and non–screen detected in 757 (57.7%). Patients with screen-detected HCC had higher proportions of early-stage HCC (393 patients [70.7%] vs 346 patients [45.7%]; risk ratio [RR], 1.54; 95% CI, 1.41-1.70) and curative treatment receipt (283 patients [51.1%] vs 252 patients [33.5%]; RR, 1.52; 95% CI, 1.34-1.74) compared with patients with non–screen-detected HCC. The screen-detected group had significantly lower mortality, which persisted after correcting for lead-time bias (hazard ratio, 0.75; 95% CI, 0.65-0.87) in fully adjusted models. Both groups had similar tumor doubling times (median [IQR], 3.8 [2.2-10.7] vs 5.6 [1.7-11.4] months) and proportions of indolent tumors (28 patients [35.4%] vs 24 patients [38.1%]; RR, 0.93; 95% CI, 0.60-1.43). Adjustment for length-time bias decreased survival estimates, although 3-year and 5-year survival for patients with screen-detected HCC remained longer than that for patients with non–screen-detected HCC.Conclusions and RelevanceThe findings of this cohort study suggest that HCC screening is associated with reduced mortality even after accounting for lead-time and length-time biases. However, these biases should be considered in future studies.

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Section: Discussionmentioning

confidence: 89%

“… 34 , 35 , 36 Efforts are needed to promote patients receiving high-quality care at multidisciplinary, high-volume settings to reduce issues regarding underuse of curative treatments. 34 , 37 , 38 , 39 …”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Screening in a Contemporary Cohort of At-Risk Patients

Daher,

Seif El Dahan,

Rich

et al. 2024

JAMA Netw Open

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“…Additionally, a comprehensive meta-analysis of 12 studies including 15,365 HCC patients suggested that MDT is associated with improved OS, with a HR of 0.63 (95% confidence interval [CI], 0.45-0.88), highlighting the potential benefits of MDT in managing HCC. 19 Nonetheless, the direct association between MDT care and an increased chance of receiving curative treatments was not statistically significant (risk ratio, 1.60; 95% CI, 0.89-2.89). It is important to note that the study was limited by high heterogeneity and potential referral bias.…”

Section: The Role and Efficacy Of Mdt In Hcc Managementmentioning

confidence: 89%

Multidisciplinary approach for hepatocellular carcinoma patients: current evidence and future perspectives

Oh,

Sinn

2024

JLC

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Management of hepatocellular carcinoma (HCC) is challenging due to the complex relationship between underlying liver disease, tumor burden, and liver function. HCC is also notorious for its high recurrence rate even after curative treatment for early-stage tumor. Liver transplantation can substantially alter patient prognosis, but donor availability varies by each patient which further complicates treatment decision. Recent advancements in HCC treatments have introduced numerous potentially efficacious treatment modalities. However, high level evidence comparing the risks and benefits of these options is limited. In this complex situation, multidisciplinary approach or multidisciplinary team care has been suggested as a valuable strategy to help cope with escalating complexity in HCC management. Multidisciplinary approach involves collaboration among medical and health care professionals from various academic disciplines to provide comprehensive care. Although evidence suggests that multidisciplinary care can enhance outcomes of HCC patients, robust data from randomized controlled trials are currently lacking. Moreover, the implementation of a multidisciplinary approach necessitates increased medical resources compared to conventional cancer care. This review summarizes the current evidence on the role of multidisciplinary approach in HCC management and explores potential future directions.

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“…Interestingly, the survival benefit of a multidisciplinary approach has been demonstrated in several studies, including a meta-analysis involving more than 15,000 patients, 69 leading to different guidelines for recommending this approach.…”

Section: A Paradigm Shift In Staging Systemsmentioning

confidence: 99%

Intermediate-stage hepatocellular carcinoma: refining substaging or shifting paradigm?

Stefanini,

Ielasi,

Pallotta

et al. 2024

JLC

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This review explores the evolution of cancer staging, focusing on intermediate hepatocellular carcinoma (HCC), and the challenges faced by physicians. The Barcelona Clinic Liver Cancer (BCLC) staging system, introduced in 1999, was designed to address the limitations associated with providing accurate prognostic information for HCC and allocating specific treatments, to avoid overtreatment. However, criticism has emerged, particularly regarding the intermediate stage of HCC (BCLC-B) and its heterogeneous patient population. To overcome this limitation, various subclassification systems, such as the Bolondi and Kinki criteria, have been proposed. These systems are aimed at refining categorizations within the intermediate stage and have demonstrated varying degrees of success in predicting outcomes through external validation. This study discusses the shift in treatment paradigms, emphasizing the need for a more personalized approach rather than strictly adhering to cancer stages, without dismissing the relevance of staging systems. It assesses the available treatment options for intermediate-stage HCC, highlighting the importance of considering surgical and nonsurgical options alongside transarterial chemoembolization for optimal outcomes. In conclusion, the text advocates for a paradigm shift in staging systems prioritizing treatment suitability over cancer stage. This reflects the evolving landscape of HCC management, where a multidisciplinary approach is crucial for tailoring treatments to individual patients, ultimately aiming to improve overall survival.

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Multidisciplinary care for patients with HCC: a systematic review and meta-analysis

Cited by 23 publications

References 47 publications

Hepatocellular Carcinoma Screening in a Contemporary Cohort of At-Risk Patients

Hepatocellular Carcinoma Screening in a Contemporary Cohort of At-Risk Patients

Multidisciplinary approach for hepatocellular carcinoma patients: current evidence and future perspectives

Intermediate-stage hepatocellular carcinoma: refining substaging or shifting paradigm?

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