Adherence to Multidisciplinary Tumor Board Decisions Determines Long-term Survival in Patients with Hepatocellular Carcinoma.

IF 6.4 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2025-09-23 DOI:10.1097/sla.0000000000006946

Robert Oehring,Fabian Jänick,Sharlyn S T Ng,Philipp Haber,Nils Haep,Can Kamali,Dominik Geisel,Uwe Pelzer,Dominik Modest,Matthäus Felsenstein,Wenzel Schöning,Raphael Mohr,Johann Pratschke,Ulrich Keilholz,Felix Krenzien

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Abstract

OBJECTIVE This study evaluated the impact of adherence to hepatobiliary multidisciplinary tumorboard (MDT) recommendations on patient outcomes, summarizing reasons for non-adherence and estimating its effect on survival. SUMMARY OF BACKGROUND DATA MDTs are essential in cancer care and recommended prior to therapy initiation. However, data on adherence to MDT recommendations remain limited. METHODS This retrospective single-center study analyzed hepatocellular carcinoma (HCC) cases presented at the hepatobiliary MDT at Charité - Universitätsmedizin Berlin between 2014 and 2018. Data were obtained from chart reviews and the clinical cancer registry. Adherence to MDT recommendations was classified as major, minor or non-adherent. RESULTS 2,104 conference cases from 879 patients with HCC were assessed. Treatment adherence was noted in 82.7% of presented cases. Overall patient-based adherence was 90.2%, with 72.2% major and 18.0% minor adherence. Median Overall survival (mOS) was significantly longer when MDT recommendations were followed (adherent: mOS 4.7 years, 95% CI: 4.5-5.9; minor adherence: 3.1 years, 95% CI: 2.15-NA; non-adherence: 1.5 years, 95% CI: 0.8-3.1; P<0.001). Reasons for MDT deviations were mainly comorbidities (29.5%), tumor progression (24%), patient preference (13.1%) or individual physician decisions (9.3%). Within the non-adherence group, both patient preferences (mOS: NA; 95% CI: 6.79-NA) and physician decisions (mOS: 4.30 y; 95% CI: 1.37-NA) were associated with comparatively longer mOS. CONCLUSIONS Adherence to MDT recommendations is associated with improved long-term survival for HCC patients. Notably, beyond tumor-related factors, patient preferences and physician decisions contributed to longer mOS and should be highly respected in selected cases.

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坚持多学科肿瘤委员会的决定决定了肝细胞癌患者的长期生存。

目的：本研究评估了遵守肝胆多学科肿瘤委员会（MDT）建议对患者预后的影响，总结了不遵守的原因，并估计了其对生存的影响。摘要：背景数据在癌症治疗中是必不可少的，建议在治疗开始前进行。然而，关于MDT建议依从性的数据仍然有限。方法：这项回顾性单中心研究分析了2014年至2018年在柏林慈善医院（charity - Universitätsmedizin Berlin）肝胆MDT就诊的肝细胞癌（HCC）病例。数据来自图表回顾和临床癌症登记处。对MDT建议的依从性分为主要、次要和非依从性。结果879例HCC患者中有2104例被评估。82.7%的病例有治疗依从性。总体患者依从性为90.2%，主要依从性为72.2%，次要依从性为18.0%。当遵循MDT建议时，中位总生存期（mOS）显着延长（坚持：mOS 4.7年，95% CI: 4.5-5.9；轻微坚持：3.1年，95% CI: 2.15-NA；不坚持：1.5年，95% CI: 0.8-3.1； P<0.001）。MDT偏离的原因主要是合并症（29.5%）、肿瘤进展（24%）、患者偏好（13.1%）或医生个人决定（9.3%）。在非依从性组中，患者偏好（mOS: NA; 95% CI: 6.79-NA）和医生决定（mOS: 4.30 y; 95% CI: 1.37-NA）与相对较长的mOS相关。结论：坚持MDT建议可提高HCC患者的长期生存率。值得注意的是，除了肿瘤相关因素外，患者的偏好和医生的决定也有助于延长生存期，在选定的病例中应高度尊重这些因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.