Establishment of a Multidisciplinary Hepatocellular Carcinoma Clinic is Associated with Improved Clinical Outcome

• Published in: Annals of surgical oncology Vol. 21; no. 4; pp. 1287 - 1295
• Main Authors: Yopp, Adam C., Mansour, John C., Beg, Muhammad S., Arenas, Juan, Trimmer, Clayton, Reddick, Mark, Pedrosa, Ivan, Khatri, Gaurav, Yakoo, Takeshi, Meyer, Jeffrey J., Shaw, Jacqueline, Marrero, Jorge A., Singal, Amit G.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-04-2014; Springer Nature B.V
• Subjects: Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Clinical outcomes; Combined Modality Therapy; Female; Follow-Up Studies; Hepatobiliary Tumors; Humans; Interdisciplinary Communication; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Outcome Assessment (Health Care); Prospective Studies; Surgery; Surgical Oncology; Survival Rate; Tace; Multidisciplinary Care; Nurse Navigator; Dallas County; Early Time Period
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-013-3413-8

Purpose
To evaluate differences in overall survival in patients with hepatocellular carcinoma (HCC) after the establishment of a multidisciplinary clinic (MDC) for HCC.
Methods
Patient demographic and tumor characteristics of 355 patients diagnosed with HCC were collected between October 2006 and September 2011. Patients diagnosed after the initiation of the HCC MDC on October 1, 2010, were compared to patients diagnosed in the 4 years before. Patient demographics, tumor characteristics, treatment regimens, and overall survival were analyzed between the groups.
Results
A total of 105 patients were diagnosed in the time period after HCC MDC initiation compared to 250 patients in the previous 4 years. Patients diagnosed with HCC after the HCC MDC had fewer symptoms at presentation (64 vs. 78 %,
p
 = 0.01) and earlier stage of tumor presentation [Barcelona Clinic for Liver Cancer (BCLC) A stage, 44 vs. 26 %,
p
 = 0.0003; tumor, node, metastasis classification system stage 1, 44 vs. 30 %,
p
 = 0.003) compared with patients diagnosed before MDC formation. The median time to treatment after diagnosis in the later period was significantly shorter than in the earlier time period (2.3 vs. 5.3 months,
p
 = 0.002). On multivariate analysis, being seen in the HCC MDC remained independently associated with better overall survival (hazard ratio 2.5, 95 % confidence interval 2–3), after adjusting for BCLC stage and recipient of curative treatment. Patients diagnosed after HCC MDC initiation had a median survival of 13.2 months compared to the 4.8 months observed in patients diagnosed before MDC formation (
p
 = 0.005).
Conclusions
The implementation of a MDC for the evaluation and treatment of patients with HCC is associated with improved overall survival.