Outcomes of patients with hepatocellular carcinoma are determined in multidisciplinary team meetings

Charrière, Bérénice; Muscari, Fabrice; Maulat, Charlotte; Bournet, Barbara; Bonnet, Delphine; Bureau, Christophe; Otal, Philippe; Péron, Jean‐Marie; Suc, B.

doi:10.1002/jso.24500

Cited by 29 publications

(24 citation statements)

References 40 publications

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“…All this makes the design of prospective trials almost impossible and explains the tremendous selection bias in most of the retrospective analyses in this field. Several studies suggest that up to a third of patients with early HCC end up receiving palliative therapies, rather than undergoing a curative approach as recommended for patients with early disease stages . This might in part be attributed to tumour location, such that patients with “difficult to reach” lesions or those not detectable on ultrasound or CT end up being placed in the palliative treatment group instead.…”

Section: Discussionmentioning

confidence: 91%

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer

Tinguely

Maurer

et al. 2019

Liver International

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Background & Aims:Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Methods: Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. Results: In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm.Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174).Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). Conclusion:Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations. K E Y W O R D Shepatocellular carcinoma, microwave ablation, navigation, stereotactic

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Section: Discussionmentioning

confidence: 91%

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer

Tinguely

Maurer

et al. 2019

Liver International

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“…Although patients in the DMT group had a more favorable stage of disease at time of presentation, the improved OS persisted for BCLC stage 2 to 4 after adjusting for stage. 13 In a 2017 study performed by Charriere et al, 14 improved OS was associated with compliance with the treatment decision made by the DMT. 14 Similar results regarding OS were obtained in a study in a Veterans Affairs system.…”

Section: Discussionmentioning

confidence: 97%

Optimizing cancer care for hepatocellular carcinoma at a safety‐net hospital: The value of a multidisciplinary disease management team

Duininck

Lopez‐Aguiar

Lee

et al. 2019

Journal of Surgical Oncology

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Background Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety‐net hospitals is unknown. Methods Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined. Results Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver‐directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001). Conclusion Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.

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“…MDT management can also shorten the interval from diagnosis to treatment [22], and increase the odds of receiving treatment for HCC [18]. In a cohort study based on data from a MDT meeting dedicated to HCC, non-adherence to the MDT recommendation was one of the negative prognostic factors for OS [20]. MDT management has another advantage as patient is being managed by a group of specialists from multiple fields.…”

Section: Discussionmentioning

confidence: 99%

“…However, MDT with participation by experts from multiple academic disciplines requires additional medical resources and time per patient, which leads to significant healthcare burden and high cost [17]. Several previous studies suggested that MDT management for HCC may improve survival [18–24], yet is limited by analyzing small number of patients [18–22], comparing patients who were treated in different time period [18,19,22], including those only received MDT management [20,21,23,24], or including those who received curative treatment only [20]. Recently, Serper et al, reported that MDT management was associated with reduced mortality, by analyzing 3,988 patients who received care through the Veterans Administration in involving 128 centers in U.S. [25].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

et al. 2019

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BackgroundGiven the complexity of managing hepatocellular carcinoma (HCC), a multidisciplinary approach (MDT) is recommended to optimize management of HCC patients. However, evidence suggesting that MDT improves patient outcome is limited.MethodsWe performed a retrospective cohort study of all patients newly-diagnosed with HCC between 2005 and 2013 (n = 6,619). The overall survival (OS) rates between the patients who were and were not managed via MDT were compared in the entire cohort (n = 6,619), and in the exactly matched cohort (n = 1,396).ResultsIn the entire cohort, the 5-year survival rate was significantly higher in the patients who were managed via MDT compared to that of the patients who were not (71.2% vs. 49.4%, P < 0.001), with an adjusted hazard ratio (HR) of 0.47 (95% confidence interval [CI]; 0.41–0.53). In the exactly matched cohort, the 5-year survival rate was higher in patients who were managed via MDT (71.4% vs. 58.7%, P < 0.001; HR [95% CI] = 0.67 [0.56–0.80]). The survival benefit of MDT management was observed in most pre-defined subgroups, and was especially significant in patients with poor liver function (ALBI grade 2 or 3), intermediate or advanced tumor stage (BCLC stage B or C), or high alphafetoprotein levels (≥200 ng/ml).ConclusionMDT management was associated with improved overall survival in HCC patients, indicating that MDT management can be a valuable option to improve outcome of HCC patients. This warrants prospective evaluations.

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Outcomes of patients with hepatocellular carcinoma are determined in multidisciplinary team meetings

Abstract: On an ITT basis, OS was similar whatever the type of curative treatment chosen in MDT. Negative prognostic factors were not following the MDT decision, elevated alpha-fetoprotein, being outside the Milan criteria. J. Surg. Oncol. 2017;115:330-336. © 2016 Wiley Periodicals, Inc.

Cited by 29 publications

References 40 publications

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Optimizing cancer care for hepatocellular carcinoma at a safety‐net hospital: The value of a multidisciplinary disease management team

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

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