TY - JOUR
T1 - Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm
T2 - 321-Patient Analysis
AU - Matsumoto, Monica M.
AU - Mouli, Samdeep
AU - Saxena, Priyali
AU - Gabr, Ahmed
AU - Riaz, Ahsun
AU - Kulik, Laura
AU - Ganger, Daniel
AU - Maddur, Haripriya
AU - Boike, Justin
AU - Flamm, Steven
AU - Moore, Christopher
AU - Kalyan, Aparna
AU - Desai, Kush
AU - Thornburg, Bartley
AU - Abecassis, Michael
AU - Hickey, Ryan
AU - Caicedo, Juan
AU - Grace, Karen
AU - Lewandowski, Robert J.
AU - Salem, Riad
N1 - Publisher Copyright:
© 2021, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
PY - 2021/7
Y1 - 2021/7
N2 - Purpose: To evaluate hepatocellular carcinoma (HCC) treatment allocation, deviation from BCLC first-treatment recommendation, and outcomes following multidisciplinary, individualized approach. Methods: Treatment-naïve HCC discussed at multidisciplinary tumor board (MDT) between 2010 and 2013 were included to allow minimum 5 years of follow-up. MDT first-treatment recommendation (resection, transplant, ablation, transarterial radioembolization (Y90), transarterial chemoembolization, sorafenib, palliation) was documented, as were subsequent treatments. Overall survival (OS) analyses were performed on an intention-to-treat (ITT) basis, stratified by BCLC stage. Results: Three hundred and twenty-one patients were treated in the 4-year period. Median age was 62 years, predominantly male (73%), hepatitis C (41%), and Y90 initial treatment (52%). There was a 76% rate of BCLC-discordant first-treatment. Median OS was not reached (57% alive at 10 years), 51.0 months, 25.4 months and 13.4 months for BCLC stages A, B, C and D, respectively. Conclusion: Deviation from BCLC guidelines was very common when individualized, MDT treatment recommendations were made. This approach yielded expected OS in BCLC A, and exceeded general guideline expectations for BCLC B, C and D. These results suggest that while guidelines are helpful, implementing a more personalized approach that incorporates center expertise, patient-specific characteristics, and the known multi-directional treatment allocation process, improves patient outcomes.
AB - Purpose: To evaluate hepatocellular carcinoma (HCC) treatment allocation, deviation from BCLC first-treatment recommendation, and outcomes following multidisciplinary, individualized approach. Methods: Treatment-naïve HCC discussed at multidisciplinary tumor board (MDT) between 2010 and 2013 were included to allow minimum 5 years of follow-up. MDT first-treatment recommendation (resection, transplant, ablation, transarterial radioembolization (Y90), transarterial chemoembolization, sorafenib, palliation) was documented, as were subsequent treatments. Overall survival (OS) analyses were performed on an intention-to-treat (ITT) basis, stratified by BCLC stage. Results: Three hundred and twenty-one patients were treated in the 4-year period. Median age was 62 years, predominantly male (73%), hepatitis C (41%), and Y90 initial treatment (52%). There was a 76% rate of BCLC-discordant first-treatment. Median OS was not reached (57% alive at 10 years), 51.0 months, 25.4 months and 13.4 months for BCLC stages A, B, C and D, respectively. Conclusion: Deviation from BCLC guidelines was very common when individualized, MDT treatment recommendations were made. This approach yielded expected OS in BCLC A, and exceeded general guideline expectations for BCLC B, C and D. These results suggest that while guidelines are helpful, implementing a more personalized approach that incorporates center expertise, patient-specific characteristics, and the known multi-directional treatment allocation process, improves patient outcomes.
KW - BCLC
KW - Hepatocellular carcinoma
KW - Multi-disciplinary tumor board
KW - Personalized care
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U2 - 10.1007/s00270-021-02810-8
DO - 10.1007/s00270-021-02810-8
M3 - Article
C2 - 33825060
AN - SCOPUS:85103668322
SN - 0174-1551
VL - 44
SP - 1070
EP - 1080
JO - Cardiovascular and Interventional Radiology
JF - Cardiovascular and Interventional Radiology
IS - 7
ER -