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Published in: CardioVascular and Interventional Radiology 7/2021

01-07-2021 | Liver Transplantation | Clinical Investigation

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

Authors: Monica M. Matsumoto, Samdeep Mouli, Priyali Saxena, Ahmed Gabr, Ahsun Riaz, Laura Kulik, Daniel Ganger, Haripriya Maddur, Justin Boike, Steven Flamm, Christopher Moore, Aparna Kalyan, Kush Desai, Bartley Thornburg, Michael Abecassis, Ryan Hickey, Juan Caicedo, Karen Grace, Robert J. Lewandowski, Riad Salem

Published in: CardioVascular and Interventional Radiology | Issue 7/2021

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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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Metadata
Title
Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient Analysis
Authors
Monica M. Matsumoto
Samdeep Mouli
Priyali Saxena
Ahmed Gabr
Ahsun Riaz
Laura Kulik
Daniel Ganger
Haripriya Maddur
Justin Boike
Steven Flamm
Christopher Moore
Aparna Kalyan
Kush Desai
Bartley Thornburg
Michael Abecassis
Ryan Hickey
Juan Caicedo
Karen Grace
Robert J. Lewandowski
Riad Salem
Publication date
01-07-2021

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