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

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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.

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Hepatocellular carcinoma


Liver transplantation


Yttrium-90 radioembolization


Barcelona Clinic Liver Cancer




Inter quartile range


95% Confidence interval


Eastern Cooperative Oncology Group performance status


Hepatitis C Virus


Hepatitis B virus


Radiofrequency ablation


Transarterial chemoembolization






Overall survival


Locoregional therapy


Multidisciplinary tumour board


Randomized control trial




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This study was not supported by any funding.

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Correspondence to Riad Salem.

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Conflict of interest

SM, AR, KD, RH, are consultants to Boston Scientific. LK is a consultant to Eisai, Bayer, Merck and Exelixis. AK is a consultant to Eisai, Exelixis, Boston Scientific, QED Therapeutics, BMS and Incyte. RJL is a consultant to Boston Scientific, Becton Dickinson, ABT and Siemens. RS is a consultant to Boston Scientific, Sirtex, Eisai, Genentech, Astrazeneca, Exelixis, Cook, Siemens and Becton Dickinson.

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Consent for procedures was obtained for every individual person’s data included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional IRB Approval for this study was obtained.

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Informed consent was obtained from all individual participants included in the study.

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Monica M. Matsumoto and Samdeep Mouli share co-first authorship.

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Matsumoto, M.M., Mouli, S., Saxena, P. et al. Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient Analysis. Cardiovasc Intervent Radiol 44, 1070–1080 (2021).

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