title: Management and patient survival in hepatocellular carcinoma: does the physician's level of experience matter?
abstract: BACKGROUND
  The prognostic determinants of hepatocellular carcinoma (HCC) depend on tumor stage, liver function reserve, and treatments offered. The clinical impact of the physician's experience on HCC management and the survival outcome is unknown.
  
  
  METHODS
  A total of 103 patients were managed by one high-volume physician and 249 patients by seven low-volume physicians. The experience of high-volume physician in HCC management was five times more than that of low-volume physicians. Patient survival was the single end point for this study.
  
  
  RESULTS
  Compared to the low-volume physician group, more of the patients allocated to the high-volume physician had early stage HCC on the date of diagnosis (66/103, 64.1%; vs 119/249, 47.8%; P = 0.008), and they received curative therapies including radiofrequency ablation or liver resection (66/103, 64.1% vs 54/249, 21.7%, P < 0.001), and had significantly better survival outcome (median survival of 34 months, 95% confidence interval [CI], 17.6-50.4; vs 6 months, 95% CI, 4.3-7.7; P < 0.001) with a multivariable-adjusted hazard ratio (HR) for survival of 1.94 (95%, CI, 1.31-2.87, P < 0.001). A multivariate analysis of the pretreatment prognostic factors for these two groups identified alpha-fetoprotein (AFP) level (HR, 1.42; 95% CI, 1.01-1.99; P = 0.042), ascites (HR, 1.68; 95% CI, 1.15-2.46; P = 0.007), maximum tumor diameter (HR, 1.78; 95% CI, 1.16-2.74; P = 0.009), and portal vein thrombosis (PVT) (HR, 2.17; 95% CI, 1.49-3.17; P < 0.001) as independent factors for the low-volume physician group. However, only maximum tumor diameter (HR, 4.54; 95% CI, 1.77-11.67; P < 0.001) and PVT (HR, 5.73; 95% CI, 2.30-14.22; P = 0.002) were independent factors for the high-volume physician group.
  
  
  CONCLUSIONS
  The survival of HCC patients was dependent on the level of experience of the physicians who oversaw these patients.
authors.affiliation: Department of Internal Medicine, Division of Hepato-Gastroenterology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
authors.forename: Tsung-Ming
authors.initials: TM
authors.lastname: Chen
authors.forename: Tzu-Ming
authors.initials: TM
authors.lastname: Chang
authors.forename: Pi-Teh
authors.initials: PT
authors.lastname: Huang
authors.forename: Ming-Hung
authors.initials: MH
authors.lastname: Tsai
authors.forename: Lien-Fu
authors.initials: LF
authors.lastname: Lin
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Liu
authors.forename: Ka-Sic
authors.initials: KS
authors.lastname: Ho
authors.forename: Chuan-Pau
authors.initials: CP
authors.lastname: Siauw
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Chao
authors.forename: Jai-Nien
authors.initials: JN
authors.lastname: Tung
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002983:Clinical Competence; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008499:Medical Records; D009367:Neoplasm Staging; D018579:Patient Selection; D010819:Physician's Role; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload