Outcomes of patients with hepatocellular carcinoma are determined in multidisciplinary team meetings.
OBJECTIVE
To analyze overall survival (OS) rates for the three curative treatments of hepatocellular carcinoma (HCC) on an intention-to-treat (ITT) basis.


METHODS
Cohort study based on data from a multidisciplinary team meeting (MDT) dedicated to HCC. From 2006 to 2013, we included every patient with newly diagnosed HCC, for whom curative treatment (liver transplantation (LT), radiofrequency ablation (RFA), surgical resection (SR)) was decided upon.


RESULTS
We included 387 consecutive patients. LT was decided in 136 cases, RFA in 131 cases, SR in 120 cases. Sixty-six percent of patients received the planned treatment. Five-year OS on an ITT basis were: 35% for the LT-group, 32% for the RFA-group, 34% for the SR-group (P = 0.77). In multivariate analyses, the main negative prognostic factors were not following the MDT decision (HR: 0.39, CI95% [0.27-0.54], P < 0.001), elevated alpha-fetoprotein level (HR: 0.63, CI95% [0.45-0.87], P = 0.005), being outside the Milan criteria (HR: 0.45, CI95% [0.31-0.65], P < 0.001). When curative treatment was performed, per-protocol 5-year OS were 64% for LT, 34% for RFA, 40% for SR.


CONCLUSIONS
On an ITT basis, OS was similar whatever the type of curative treatment chosen in MDT. Negative prognostic factors were not following the MDT decision, elevated alpha-fetoprotein, being outside the Milan criteria. J. Surg. Oncol. 2017;115:330-336. © 2016 Wiley Periodicals, Inc.
Service de chirurgie digestive et hépatobiliaire, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.
Bérénice
B
Charriere
Service de chirurgie digestive et hépatobiliaire, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.
Fabrice
F
Muscari
Service de chirurgie digestive et hépatobiliaire, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.
Charlotte
C
Maulat
Service de gastro-entérologie, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.
Barbara
B
Bournet
Service de médecine interne, Centre Hospitalier Universitaire Purpan, Université Paul Sabatier III, Toulouse, France.
Delphine
D
Bonnet
Service d'hépato-gastro-entérologie, Centre Hospitalier Universitaire Purpan, Université Paul Sabatier III, Toulouse, France.
Christophe
C
Bureau
Service de radiologie, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.
Philippe
P
Otal
Service d'hépato-gastro-entérologie, Centre Hospitalier Universitaire Purpan, Université Paul Sabatier III, Toulouse, France.
Jean-Marie
JM
Peron
Service de chirurgie digestive et hépatobiliaire, Centre Hospitalier Universitaire Rangueil, Université Paul Sabatier III, Toulouse, France.
Bertrand
B
Suc
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
Milan criteria; alpha-fetoprotein; hepatocellular carcinoma; intention-to-treat; liver transplantation