Utility of multidisciplinary tumor board (MTB) in the management of hepatocellular cancer (HCC)

Date

08 Oct 2016

Session

Poster Display

Presenters

Asrar Alahmadi

Citation

Annals of Oncology (2016) 27 (6): 207-242. 10.1093/annonc/mdw371

Authors

A. Alahmadi1, R. Lee2, C. Siegel3, P. Gholam4

Author affiliations

  • 1 Division Of Internal Medicine, University Hospitals Case Medical Center, 44106 - Cleveland/US
  • 2 Division Of Hematology And Oncology, University Hospitals Case Medical Center, Case Comprehensive Cancer Center, 44106 - Cleveland/US
  • 3 Division Of Hepatobiliary And Transplant Surgery, University Hospitals Case Medical Center, Case Comprehensive Cancer Center, 44106 - Cleveland/US
  • 4 Digestive Health Institute, Transplant Institute, University Hospitals Case Medical Center, Case Comprehensive Cancer Center, 44106 - Cleveland/US
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Background

MTBs are routinely used and a requirement for comprehensive cancer centers. However, the impact of MTB is not well characterized. We studied the recommendations of MTBs on the clinical outcomes of all HCC patients presented at our liver MTB, in comparison to the 2005 practice guidelines of the American Association for the Study of Liver Disease (AASLD).

Methods

Data were retrospectively collected for all patients with newly diagnosed HCC and presented to our liver MTB. Patients were followed up until the time of death, there last known follow-up or time of transplantation. Patients were staged at baseline using the Barcelona Clinic Liver Cancer (BCLC) staging classification. Median overall survival (OS) rates were calculated using a standard Kaplan-Meier and Cox regression model with SPSS software (v. 23).

Results

A 312 patients out of 380 were enrolled. The average age was 62.8 years with 77.9% males. Hepatitis C was the most common etiology of HCC (57.7%). In our cohort 51% of the MTB recommendations were adherent to the guidelines. The first line treatment suggested by the MTB and its adherence with AASLD guidelines by stage are shown in Table 1. Our data shows that adherence to AASLD guidelines was associated with significantly longer OS in BCLC A by 21 months (HR 1.59; 95% CI 1.26-2.02). On the other hand, the OS was significantly longer in BCLC D that was not treated according to the AASLD guidelines by 7 months (HR 0.413; 95% CI 0.25-0.69). Many patients in BCLC B/C did not receive AASLD recommended treatment, and their OS were not any different.

First line treatment and Adherence to AASLD Guidelines

Treatment BCLC A n = 139 BCLC B n = 56 BCLC C n = 83 BCLC D n = 34
Surgical resection 32 7 14 2
Transplant referral 24 3 0 6
RFA 28 3 0 0
Cyberknife 7 3 5 1
Y90 11 11 10 1
TACE 28 15 12 1
Sorafenib 3 5 21 3
Clinical trial 0 1 0 0
Supportive care 6 8 21 20
Adherence to AASLD guidelines (%) 73.3% 26.8% 25.3% 58.8%

Conclusions

In clinical practice, the adherence to published guidelines is limited and subject to the heterogeneity of the patients and their comorbidities. MTB had a positive impact on BCLC D OS. The findings in our study suggest the need to refine the current staging and guidelines for HCC, especially for BCLC B, C, and D. MTBs need to have a bigger role in facilitating clinical trial participation.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

Case Medical Center

Disclosure

P. Gholam: Consultant: Bayer. All other authors have declared no conflicts of interest.

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