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Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1287–1295 | Cite as

Establishment of a Multidisciplinary Hepatocellular Carcinoma Clinic is Associated with Improved Clinical Outcome

  • Adam C. YoppEmail author
  • 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
Hepatobiliary Tumors

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.

Keywords

Tace Multidisciplinary Care Early Time Period Nurse Navigator Dallas County 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Supported in part by grants KL2 RR024983-04 and UL1 RR024982. The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, the University of Texas Southwestern Medical Center and its affiliated academic and health care centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Adam C. Yopp
    • 1
    Email author
  • John C. Mansour
    • 1
  • Muhammad S. Beg
    • 2
  • Juan Arenas
    • 3
  • Clayton Trimmer
    • 4
  • Mark Reddick
    • 4
  • Ivan Pedrosa
    • 5
  • Gaurav Khatri
    • 5
  • Takeshi Yakoo
    • 5
  • Jeffrey J. Meyer
    • 6
  • Jacqueline Shaw
    • 1
  • Jorge A. Marrero
    • 7
  • Amit G. Singal
    • 7
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Division of Medical Oncology, Department of MedicineUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Division of Abdominal Transplantation, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  4. 4.Division of Interventional Radiology, Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasUSA
  5. 5.Division of Magnetic Resonance Imaging/Abdominal Imaging, Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasUSA
  6. 6.Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasUSA
  7. 7.Division of Digestive and Liver Diseases, Department of MedicineUniversity of Texas Southwestern Medical CenterDallasUSA

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