title: Imaging surveillance and multidisciplinary review improves curative therapy access and survival in HCC patients.
abstract: BACKGROUND
  Imaging surveillance and multidisciplinary conference (MDC) review can potentially improve survival in patients with hepatocellular carcinoma (HCC) by increasing access to liver transplantation. Geographic disparities in donor organ availability may reduce this benefit. This study evaluated the impact of HCC surveillance on use of curative therapies and survival in a region with long transplant waiting times.
  
  
  METHODS
  167 HCC patients were retrospectively studied. Subjects had an established HCC diagnosis or were diagnosed during hepatology follow-up. Collected data included patient demographics, HCC surveillance and MDC review status, portal hypertension complications, laboratory and radiologic parameters, tumor size, therapeutic interventions, tumor progression, and mortality. The primary outcome measures were use of curative treatments and survival. A Cox-regression model was constructed utilizing factors associated with survival in univariate analysis.
  
  
  RESULTS
  58% of subjects underwent surveillance and MDC review of HCC. These patients were more likely to have received treatment with ablation or resection (16 vs. 3%, P = 0.006) and transplantation (23 vs. 4%, P = 0.001), and were less likely to develop tumor progression (45 vs. 68%, P = 0.005) or metastases (0 vs. 19%, P < 0.001). In multivariate analysis, surveillance and MDC review (P = 0.034, HR 0.520, 95% CI 0.284-0.952), tumor meeting Milan criteria (P < 0.001, HR 0.329, 95% CI 0.178-0.607), curative therapy application (P = 0.048, HR 0.130, 95% CI 0.017-0.979), and transplantation (P = 0.004, HR 0.236, 95% CI 0.088-0.632) were associated with survival.
  
  
  CONCLUSIONS
  In conclusion, imaging surveillance and MDC review is associated with detection of early stage HCC, increased access to curative therapies and transplantation, and prolonged survival.
authors.affiliation: University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.forename: Eric R
authors.initials: ER
authors.lastname: Kallwitz
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Von Roenn
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Berkes
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cotler
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D003952:Diagnostic Imaging / Q000379:methods; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D010348:Patient Care Team; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality