Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Apr;21(4):1287-95.
doi: 10.1245/s10434-013-3413-8. Epub 2013 Dec 7.

Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome

Adam C Yopp  1 , John C Mansour, Muhammad S Beg, Juan Arenas, Clayton Trimmer, Mark Reddick, Ivan Pedrosa, Gaurav Khatri, Takeshi Yakoo, Jeffrey J Meyer, Jacqueline Shaw, Jorge A Marrero, Amit G Singal
Affiliations
Comparative Study

Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome

Adam C Yopp et al. Ann Surg Oncol. 2014 Apr.

Abstract

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.

PubMed Disclaimer

Figures

FIG. 1
FIG. 1
Kaplan–Meier estimated overall survival curves of patients (a) diagnosed after (blue line) or before (yellow line) the initiation of the HCC MDC and (b) either diagnosed after the initiation of the HCC MDC or who were diagnosed before MDC initiation but whose decision for treatment was made within the confines of the clinic (group 1) (blue line) versus patients who were diagnosed before MDC formation and either received no treatment or initial treatment before MDC formation (group 2) (yellow line)
FIG. 2
FIG. 2
Flow diagram of patients diagnosed with HCC before and after initiation of the HCC MDC
See this image and copyright information in PMC

Comment in

References

    1. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153–6. - PubMed
    1. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340:745–50. - PubMed
    1. Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol. 2011;18:2116–25. - PubMed
    1. Pawlik TM, Laheru D, Hruban RH, Coleman J, Wolfgang CL, Campbell K, et al. Evaluating the impact of a single-day multi-disciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 2008;15:2081–8. - PMC - PubMed
    1. Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer. 2001;91:1231–7. - PubMed

Publication types

LinkOut - more resources