Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma

Abstract

Background

Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board’s recommended treatment.

Purpose

This study aims to assess adherence to MDLTB recommendations for the treatment of HCC, the reasons for non-adherence, and the survival of Barcelona Clinic Liver Cancer (BCLC) Stage A patients treated with curative treatment compared to palliative locoregional therapy.

Patients and Methods

A single-site, retrospective cohort study was conducted of all patients with treatment-naïve HCC who were evaluated by an MDLTB at a tertiary care center in Connecticut between 2013 and 2016, of which 225 patients met inclusion criteria. Investigators conducted a chart review and recorded adherence to the MDLTB’s recommendations, and in cases of discordance, evaluated and recorded the underlying cause; investigators assessed MDLTB recommendations’ compliance with BCLC guidelines. Survival data was accrued through February 1st of 2022 and analyzed via Kaplan–Meier analysis and multivariate Cox regression.

Results

Treatment adherent to MDLTB recommendations occurred in 85.3% of patients (n=192). The majority of non-adherence occurred in the management of BCLC Stage A disease. In cases where adherence was possible but the recommendation was not followed, most discrepancies were whether to treat with curative or palliative intent (20/24), with almost all discrepancies occurring in patients (19/20) with BCLC Stage A disease. For patients with Stage A unifocal HCC, those who received curative therapy lived significantly longer than patients who received palliative locoregional therapy (5.55 years vs 4.26 years, p=0.037).

Conclusion

Most forms of non-adherence to MDLTB recommendations were unavoidable; however, treatment discordance in the management of patients with BCLC Stage A unifocal disease may present an opportunity for clinically significant quality improvement.

Keywords:

• compliance
• multidisciplinary liver tumor board
• HCC
• treatment guidelines

Abbreviations

ALBI, albumin-bilirubin; BCLC, Barcelona-Clinic Liver Cancer; ECOG, Eastern Cooperative Oncology Group; HCC, hepatocellular carcinoma; MELD, model of end-stage liver disease; MDLTB, multidisciplinary liver tumor board; PS, performance status; TACE, transarterial chemoembolization.

Disclosure

Dr Mario Strazzabosco reports that he is an advisor (received no compensation) for ENGITIX, outside the submitted work. The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by NIH T32DK007356, Yale Liver Center P30DK034989, and Training grant T32DK007356.