Establishment of a Multidisciplinary Hepatocellular Carcinoma Clinic is Associated with Improved Clinical Outcome
Establishment of a Multidisciplinary Hepatocellular Carcinoma Clinic is Associated with Improved Clinical Outcome
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DOI：
10.1245/s10434-013-3413-8
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发表时间：
2014-04-01
影响因子：
3.7
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
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作者：
Yopp, Adam C.;Mansour, John C.;Singal, Amit G.
目的.评估在建立多学科肝癌诊所（MDC）后，肝细胞癌（HCC）患者总生存率的差异。收集了2006年10月至2011年9月期间诊断为HCC的355例患者的人口统计学和肿瘤特征。将2010年10月1日开始HCC MDC后诊断的患者与4年前诊断的患者进行比较。分析两组患者的人口统计学资料、肿瘤特征、治疗方案和总生存率。在HCC MDC启动后的时间段内，共有105例患者被诊断出，而前4年有250例患者。HCC MDC后诊断为HCC的患者在就诊时症状较少（64 vs. 78%，p = 0.01）和肿瘤表现的早期[巴塞罗那肝癌诊所（BCLC）A期，44 vs. 26%，p = 0.0003;肿瘤、淋巴结、转移分类系统1期，44对30%，p = 0.003）与MDC形成前诊断的患者相比。晚期诊断后至治疗的中位时间显著短于早期（2.3 vs. 5.3个月，p = 0.002）。在多变量分析中，在校正BCLC分期和接受根治性治疗后，在HCC MDC中观察到与更好的总生存率独立相关（风险比2.5，95%置信区间2-3）。HCC MDC启动后确诊的患者中位生存期为13.2个月，而MDC形成前确诊的患者中位生存期为4.8个月（p = 0.005）。实施MDC评估和治疗HCC患者与改善总生存率相关。
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.