Monica M Matsumoto1,2, Samdeep Mouli1, Priyali Saxena1, Ahmed Gabr1, Ahsun Riaz1, Laura Kulik3, Daniel Ganger3, Haripriya Maddur3, Justin Boike3, Steven Flamm3, Christopher Moore3, Aparna Kalyan4, Kush Desai1, Bartley Thornburg1, Michael Abecassis5, Ryan Hickey6, Juan Caicedo7, Karen Grace1, Robert J Lewandowski1,4,7, Riad Salem8,9,10. 1. Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA. 2. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA. 3. Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA. 4. Division of Medical Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA. 5. College of Medicine, University of Arizona, Tucson, AZ, USA. 6. Section of Interventional Radiology, Department of Radiology, New York University, New York, NY, USA. 7. Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA. 8. Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA. r-salem@northwestern.edu. 9. Division of Medical Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA. r-salem@northwestern.edu. 10. Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA. r-salem@northwestern.edu.
Abstract
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.
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.
Entities:
Keywords:
BCLC; Hepatocellular carcinoma; Multi-disciplinary tumor board; Personalized care
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