Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

Abstract

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.

Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome

“…Intuitively having MTB and therefore a group of experts discuss every case is the obvious choice, but the literature is not as clear yet concerning the evidence for an improved clinical outcome. While many single tumor entity group studies show an improvement in OS [1][2][3][4][5][6][7][8] some found no relevant improvement of the clinical outcome [9,10]. Studies evaluating OS in MTB across different tumor entity groups by literature reviews [13] or comparison of centers with and without MTB [14] show weak to no evidence.…”

“…While the number of tumor boards continued to grow over this period, it is important to evaluate the benefit of this effort for the patient. Previous studies were able to show improvement of survival for some specific tumor entity groups like lung cancer [1][2][3], head and neck cancer [4,5], hepatocellular cancer [6,7] and breast cancer [8] while some other studies did not show an significant improvement of survival for entities like pancreatic cancer [9] colorectal cancer [10], multiple myelomas [11] or metastatic germ cell tumors [12]. Analyses which tried to draw the big picture by taking multiple entities into consideration via metanalysis [13] or general comparison of cancer centers with and without multidisciplinary tumor board meetings [14] showed little to no evidence of an improved clinical outcome.…”

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

“…This vulnerable patient group is likely to have more liver‐related comorbidities that require close surveillance. Thus, in patients with HCV‐related HCC, particularly with the presence of cirrhosis, monitoring of liver function and the selection of DAA regimens should be considered, preferably via multidisciplinary approach (MDT)—which is becoming a common practice in many tertiary medical centres—to achieve optimal treatment outcomes.…”

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

“…To select the factors for multivariate analysis, the stepwise procedure was used as previously described . Although the BCLB staging system includes liver function and tumor size, both the BCLC staging system and ALBI score were applied for the stepwise procedure as previously described . Factors associated with overall survival were evaluated using multivariate and decision‐tree analyses as previously described .…”