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Outcomes of patients with hepatocellular carcinoma are determined in multidisciplinary team meetings

Bérénice Charriere1, Fabrice Muscari1, Charlotte Maulat1

  • 1Service de chirurgie digestive et hépatobiliaire, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.

Journal of Surgical Oncology
|November 5, 2016
PubMed

Insights

Overall survival rates for hepatocellular carcinoma (HCC) curative treatments were similar on an intention-to-treat (ITT) basis. Key negative prognostic factors included not adhering to multidisciplinary team (MDT) decisions and elevated alpha-fetoprotein levels.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Hepatocellular carcinoma (HCC) is a significant global health concern.
  • Curative treatment options for HCC include liver transplantation (LT), radiofrequency ablation (RFA), and surgical resection (SR).
  • Assessing treatment efficacy on an intention-to-treat (ITT) basis is crucial for clinical decision-making.

Purpose of the Study:

  • To compare overall survival (OS) rates for LT, RFA, and SR in HCC patients.
  • To evaluate the impact of multidisciplinary team (MDT) decisions on treatment outcomes.
  • To identify prognostic factors influencing survival in HCC patients undergoing curative treatment.

Main Methods:

  • A cohort study was conducted using data from an HCC-dedicated multidisciplinary team meeting (MDT).
  • Patients diagnosed with HCC between 2006 and 2013, with a decided curative treatment (LT, RFA, or SR), were included.
  • Overall survival (OS) was analyzed on an intention-to-treat (ITT) basis.

Main Results:

  • Five-year OS rates on an ITT basis were comparable across LT (35%), RFA (32%), and SR (34%) groups (P=0.77).
  • Sixty-six percent of patients received their planned curative treatment.
  • Multivariate analysis identified non-adherence to MDT decisions (HR: 0.39), elevated alpha-fetoprotein (HR: 0.63), and exclusion from Milan criteria (HR: 0.45) as negative prognostic factors.

Conclusions:

  • Intention-to-treat (ITT) overall survival (OS) was similar for liver transplantation (LT), radiofrequency ablation (RFA), and surgical resection (SR) in hepatocellular carcinoma (HCC).
  • Adherence to multidisciplinary team (MDT) recommendations is critical for improving patient outcomes.
  • Elevated alpha-fetoprotein levels and exceeding Milan criteria significantly worsen prognosis in HCC patients.
Abstract

Keywords:
Milan criteriaalpha-fetoproteinhepatocellular carcinomaintention-to-treatliver transplantation

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