Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient Analysis

• DOI: 10.1007/s00270-021-02810-8
• Publication Date: 2021-04-06T21:02:58Z
• Authors: Monica M. Matsumoto; Samdeep Mouli; Priyali Saxena; Ahmed Gabr; Ahsun Riaz; Laura Kulik; Daniel Ganger; Haripriya Maddur; Justin Boike; Steven Flamm; Christopher Moore; Aparna Kalyan; Kush Desai; Bartley Thornburg; Michael Abecassis; Ryan Hickey; Juan Caicedo; Karen Grace; Robert J. Lewando...; Riad Salem
• Keywords: Adult; Aged, 80 and over; Male; 0301 basic medicine; Carcinoma, Hepatocellular; Brachytherapy; Liver Neoplasms; Antineoplastic Agents; Middle Aged; 3. Good health; 03 medical and health sciences; Treatment Outcome; Practice Guidelines as Topic; Humans; Female; Chemoembolization, Therapeutic; Algorithms; Aged; Neoplasm Staging

To evaluate hepatocellular carcinoma (HCC) treatment allocation, deviation from BCLC first-treatment recommendation, and outcomes following multidisciplinary, individualized approach.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.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.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.