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Real-World Analysis of Multidisciplinary Roles in the Management of Hepatocellular Carcinoma: The Mayo Clinic
Fatima Z Islam1, Cynthia De La Garza-Ramos1, Umair Majeed2
1Department of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.
Insights
Interventional radiology (IR) is key in multidisciplinary hepatocellular carcinoma (HCC) care, especially for early stages. Hepatology is vital for evaluation, while medical oncology manages intermediate stages, and locoregional therapy is used for advanced HCC.
Area of Science:
- Oncology
- Hepatology
- Interventional Radiology
Background:
- Hepatocellular carcinoma (HCC) management requires multidisciplinary care.
- Real-world specialty involvement patterns in HCC are not well-defined.
Purpose of the Study:
- To map specialty care pathways for HCC patients.
- To analyze the roles of different medical specialties in HCC treatment.
Main Methods:
- Retrospective review of HCC patient treatments (May 2020-May 2025).
- Analysis of therapeutic events across interventional radiology, medical oncology, transplant surgery, radiation oncology, and hepatopancreatobiliary surgery.
- Stratification by treatment line and Barcelona Clinic Liver Cancer (BCLC) stage.
Main Results:
- Hepatology consulted 87% of HCC patients.
- Interventional radiology (IR) was the most common first-line treatment provider (37%), especially for early BCLC stages (0, A).
- Medical oncology predominated for intermediate (B) and advanced (C) stages, with locoregional therapies used in 27% of BCLC C patients.
Conclusions:
- IR is a procedural cornerstone in multidisciplinary HCC care, particularly for early-stage disease.
- Hepatology is crucial for initial evaluation and care coordination.
- Findings inform resource allocation and care strategies for evolving HCC management.
Background:
Hepatocellular carcinoma (HCC) is a complex disease best managed through multidisciplinary care, yet real-world patterns of medical specialty involvement remain poorly characterized. This study mapped specialty care pathways for HCC patients treated at the three Mayo Clinic destination medical centers.
Methods:
A retrospective review was performed using the Mayo Data Explorer for treatments delivered between May 2020 and May 2025. Patients with HCC were identified through diagnosis codes or hepatology consultation. Therapeutic events across interventional radiology (IR), medical oncology, transplant surgery, radiation oncology, and hepatopancreatobiliary surgery (HPBS) were analyzed descriptively by treatment line and Barcelona Clinic Liver Cancer (BCLC) stage.
Results:
Of 6051 HCC patients identified, 4799 met inclusion criteria. Hepatology provided consultation for 87% of patients (n=4183). For first-line treatments (n=3079), 37% received initial therapy from IR, 27% from medical oncology, 17% from transplant surgery, 10% from HPBS, and 9% from radiation oncology. IR remained the most common provider across subsequent treatment lines. Analyses were based on treatment events, and some patients contributed to multiple treatment lines. Among patients with documented BCLC stage (n = 906), IR most frequently delivered initial therapy for stages 0 and A, whereas medical oncology predominated for stages B and C. Locoregional therapies were used in 27% of BCLC C patients.
Conclusion:
This real-world mapping reveals IR as a procedural cornerstone within multidisciplinary HCC management, particularly for early-stage disease. Hepatology remains essential for initial patient evaluation and care coordination. Medical oncology predominates for intermediate-stage disease, while locoregional therapy continues to be used in a substantial proportion of advanced-stage cases. These findings highlight the complex and evolving role of subspecialties in the management of HCC and may inform future resource allocation and care strategies.
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