title: Impact of hepatologists to extend survival of hepatocellular carcinoma patients with cirrhosis: a comparison with non-hepatologists.
abstract: OBJECTIVE
  Whether or not generalists and specialist physicians can make an appropriate adaptation of their practice patterns when caring for their patients currently remains a matter of debate. The present study was undertaken to explore whether the clinical characteristics of hepatocellular carcinoma at its time of detection, the initial treatment options and the survival vary between patients with hepatocellular carcinoma associated with cirrhosis who were treated by hepatologists and those who were treated by non-hepatologists.
  
  
  METHODS
  A retrospective study with 626 patients with hepatocellular carcinoma associated with cirrhosis was performed. The patients were stratified into three groups as follows; 1) a hepatologist group: 280 patients followed up and treated consistently by hepatologists, 2) a non-hepatologist group: 126 patients followed up and treated consistently by non-hepatologists, and 3) the other group: 220 patients either followed up by hepatologists and treated by non-hepatologists, or vice versa, or those identified to have tumors incidentally without any follow-up. To confirm the clear difference between generalists and specialists, the gender ratio, age, hepatitis B and C virus markers, serum alpha-fetoprotein level, tumor size, the number of tumors, Child's grade, portal thrombosis at the initial detection, the types of follow-up until the initial detection of hepatocellular carcinoma, the initial treatments chosen, and survival were compared between the hepatologist group and the non-hepatologist group.
  
  
  RESULTS
  There were no statistically significant differences between the two groups with respect to gender ratio, age, hepatitis virus markers and the alpha-fetoprotein level. However, the tumor size, the number of tumors, Child's grade and portal thrombosis at the initial detection were more advanced in the non-hepatologist group, which was most likely due to the poorer follow-up until the detection of hepatocellular carcinoma compared with that in the hepatologist group (p value: 0.0237). Regarding therapy for hepatocellular carcinoma, intensive therapies were more often performed in the hepatologist group and, in addition, non-treated cases were less frequently found in the hepatologist group. Consequently, the 1-, 3- and 5-year survivals of the patients in the hepatologist group were 84.7, 61.1 and 35.1%, respectively, which were significantly longer than those in the non-hepatologist group, which were 80.7, 45.8 and 31.8%, respectively (p value: 0.0434).
  
  
  CONCLUSIONS
  Hepatocellular carcinoma patients with cirrhosis who were treated by hepatologists can expect to obtain a longer survival because hepatocellular carcinoma tends to be detected at a smaller size, while such patients also usually receive more appropriate treatment modalities.
authors.affiliation: Clinical Research Center, National Nagasaki Medical Center, Omura, Japan. dohmenk@par.odn.ne.jp
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Dohmen
authors.forename: Masafumi
authors.initials: M
authors.lastname: Shirahama
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Shigematsu
authors.forename: Koji
authors.initials: K
authors.lastname: Irie
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ishibashi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy / Q000821:virology; D016461:Chemoembolization, Therapeutic; D002983:Clinical Competence; D003287:Contrast Media; D005260:Female; D005762:Gastroenterology; D006801:Humans; D007459:Iodized Oil; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy / Q000821:virology; D008297:Male; D010818:Practice Patterns, Physicians'; D015642:Radiology, Interventional; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D003287:Contrast Media; D007459:Iodized Oil