Creating a Multidisciplinary Hepatocellular Carcinoma Clinic Improves Survival

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(ChemotherapyAdvisor) – Forming a multidisciplinary clinic to diagnose and treat patients with hepatocellular carcinoma (HCC) resulted in improved survival, most likely from more streamlined care that resulted in a diagnosis of HCC at an earlier tumor stage and a shorter time to treatment, results of a study presented at the 66th Annual Society of Surgical Oncology (SSO) Cancer Symposium, held in National Harbor, MD, has found.

Although multidisciplinary clinics are prevalent in the management of care, data that demonstrate improved outcomes are lacking, noted Adam C. Yopp, MD, a surgical oncologist at UT Southwestern Medical Center in Dallas, TX, and colleagues. This is especially important in HCC, in which the variability of liver-specific and tumor-specific factors “mandates multimodal therapy,” they added.

In October 2010, the investigators created a multidisciplinary clinic comprising surgeons, hepatologists, oncologists, and radiologists to evaluate patients with HCC or suspected HCC, defined as any liver mass on radiology or elevated alpha-fetoprotein. They then “conducted a retrospective review of a prospective HCC database to identify patients diagnosed in the year following and 3 years prior to initiation of the multidisciplinary clinic,” Dr. Yopp stated.

A total of 105 patients were identified in the year after the multidisciplinary clinic was opened and 209 patients in the 3 previous years. No difference in gender, race/ethnicity, etiology of cirrhosis, or Child-Pugh stage was observed between the two groups.

Patients who were diagnosed after the multidisciplinary clinic was initiated had HCC found at earlier tumor stages by American Joint Committee on Cancer and Barcelona Clinic Liver Cancer (BCLC) classification (P=0.001 and P=0.003, respectively). In addition, more patients received treatment (56% vs. 44%, P=0.04), and time-to-treatment was shorter (2.2 vs. 4.6 months, P=0.001), compared with patients diagnosed before the clinic was operational, respectively.

Median survival was significantly longer than those seen during the 3 prior years (15.2 vs. 4.7 months, P=0.002). “This difference in survival persisted when patients who were lost to follow-up or died within 1 month of HCC diagnosis were excluded (17.7 vs. 7.0 months, P=0.004),” the investigators reported. After excluding patients with BCLC D stage (advanced) disease, survival was also longer in the post-clinic period; 1-year survival was 64% compared with 47% (P=0.001).

The abstract (#58) for this presentation is available at the 66th Annual SSO Cancer Symposium's website.

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