title: Influence of nonclinical factors on choice of therapy for early hepatocellular carcinoma.
abstract: BACKGROUND
  Initial therapy for early hepatocellular carcinoma (HCC) with well-compensated cirrhosis is controversial. While we previously reported on the effect of clinical factors and surgeon specialty on choice of therapy for early HCC, other nonclinical factors also may impact decision-making.
  
  
  METHODS
  Surgeons who treat HCC were invited to complete a web-based survey that included ten case scenarios. Choice of therapy-liver transplantation (LT), liver resection (LR), or radiofrequency ablation (RFA)-was analyzed using regression models.
  
  
  RESULTS
  There were 336 responses for analysis. Most respondents were in academic centers (86 %) that offered LT (71 %). The median number of patients annually evaluated for HCC was 30. Both practice type and HCC case volume were associated with choice of therapy, but these associations were not independent of surgeon specialty. LT surgeons who did not also perform RFA were less likely than those LT surgeons who did offer RFA to choose RFA over LT (relative risk ratios (RRR) 0.38, P < 0.001). Non-LT surgeons were more likely than LT surgeons who also offered RFA to choose RFA over LT (RRR 2.24, P < 0.001). Surgeons who worked at hospitals where LT was performed were much more likely to choose LT over LR and RFA even if they did not personally perform LT (RRR 1.27 and RRR 3.33, P < 0.001).
  
  
  CONCLUSIONS
  Surgeon- and institution-related factors impact choice of therapy for early HCC even after adjustment for differences in clinical presentation. These data suggest that choice of therapy for patients with early HCC varies across providers independent of case selection.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: John F P
authors.initials: JF
authors.lastname: Bridges
authors.forename: Allan B
authors.initials: AB
authors.lastname: Massie
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Cameron
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011379:Prognosis