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

CardioVascular and Interventional Radiology volume 44, pages 1070–1080 (2021)Cite this article

Abstract

Purpose

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

Methods

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.

Results

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.

Conclusion

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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Abbreviations

HCC:

Hepatocellular carcinoma

LT:

Liver transplantation

Y90:

Yttrium-90 radioembolization

BCLC:

Barcelona Clinic Liver Cancer

CP:

Child–Pugh

IQR:

Inter quartile range

CI:

95% Confidence interval

ECOG-PS:

Eastern Cooperative Oncology Group performance status

HCV:

Hepatitis C Virus

HBV:

Hepatitis B virus

RFA:

Radiofrequency ablation

TACE:

Transarterial chemoembolization

ALBI:

Albumin-bilirubin

ITT:

Intention-to-treat

OS:

Overall survival

LRT:

Locoregional therapy

MDT:

Multidisciplinary tumour board

RCT:

Randomized control trial

KM:

Kaplan–Meier

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Monica M. Matsumoto, Samdeep Mouli, Priyali Saxena, Ahmed Gabr, Ahsun Riaz, Kush Desai, Bartley Thornburg, Karen Grace, Robert J. Lewandowski & Riad Salem

  2. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Monica M. Matsumoto

  3. Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA

    Laura Kulik, Daniel Ganger, Haripriya Maddur, Justin Boike, Steven Flamm & Christopher Moore

  4. Division of Medical Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA

    Aparna Kalyan, Robert J. Lewandowski & Riad Salem

  5. College of Medicine, University of Arizona, Tucson, AZ, USA

    Michael Abecassis

  6. Section of Interventional Radiology, Department of Radiology, New York University, New York, NY, USA

    Ryan Hickey

  7. Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA

    Juan Caicedo, Robert J. Lewandowski & Riad Salem

Authors
  1. Monica M. Matsumoto
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  2. Samdeep Mouli
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  3. Priyali Saxena
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  4. Ahmed Gabr
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  5. Ahsun Riaz
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  6. Laura Kulik
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  7. Daniel Ganger
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  8. Haripriya Maddur
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  9. Justin Boike
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  10. Steven Flamm
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  11. Christopher Moore
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  12. Aparna Kalyan
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  13. Kush Desai
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  14. Bartley Thornburg
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  15. Michael Abecassis
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  16. Ryan Hickey
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  17. Juan Caicedo
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  18. Karen Grace
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  19. Robert J. Lewandowski
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  20. Riad Salem
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Corresponding author

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.

Consent for Application

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

Ethical Approval

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.

Informed Consent

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). https://doi.org/10.1007/s00270-021-02810-8

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  • DOI: https://doi.org/10.1007/s00270-021-02810-8

Keywords

  • BCLC
  • Personalized care
  • Hepatocellular carcinoma
  • Multi-disciplinary tumor board