Clinical decision-making by gastroenterologists and hepatologists for patients with early hepatocellular carcinoma

Hari Nathan, H. Franklin Herlong, Ahmet Gurakar, Zhiping Li, Ayman A. Koteish, John F P Bridges, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Choice of therapy in early hepatocellular carcinoma (HCC) is controversial, and no broad consensus exists as to how patient and tumor characteristics should be used to guide choice of therapy. We have previously reported on decision making in early HCC by liver surgeons. In the present study, we quantified the impact of clinical factors on choice of therapy for early HCC by gastroenterologists and hepatologists. Methods: Physicians who treat HCC were invited to complete a web-based survey including ten case scenarios that systematically varied across seven clinical factors. Choice of therapy - liver transplantation (LT), liver resection (LR), radiofrequency ablation or intra-arterial therapy - was analyzed using multinomial logistic regression models. Results: Tumor number and size, type of resection required, biological Model for End-Stage Liver Disease (MELD) score, and platelet count had the largest effects on choice of therapy. For example, LR was more likely to be recommended over LT for patients with small solitary tumors versus multiple tumors [relative risk ratio (RRR) 3.63], those who would require a minor versus major LR (RRR 3.39), those with lower biological MELD score (6 vs. 10; RRR 1.95), and those with a higher platelet count (150,000/μL vs. 70,000/μL; RRR 2.77). In contrast, serum α-fetoprotein level and etiology of cirrhosis were not associated with choice of therapy. No physician-related factors studied had an impact on choice of therapy. Conclusion: The clinical factors weighed most heavily by gastroenterologists and hepatologists are quite similar to those considered important by surgeons. There was good consensus among gastroenterologists and hepatologists as to the factors used to choose therapy.

Original languageEnglish (US)
Pages (from-to)1844-1851
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number6
DOIs
StatePublished - 2014

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Hepatocellular Carcinoma
Odds Ratio
Biological Models
End Stage Liver Disease
Therapeutics
Liver
Platelet Count
Liver Transplantation
Neoplasms
Consensus
Logistic Models
Fetal Proteins
Physicians
Gastroenterologists
Clinical Decision-Making
Decision Making
Fibrosis
Serum

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

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Clinical decision-making by gastroenterologists and hepatologists for patients with early hepatocellular carcinoma. / Nathan, Hari; Herlong, H. Franklin; Gurakar, Ahmet; Li, Zhiping; Koteish, Ayman A.; Bridges, John F P; Pawlik, Timothy M.

In: Annals of Surgical Oncology, Vol. 21, No. 6, 2014, p. 1844-1851.

Research output: Contribution to journalArticle

Nathan, Hari ; Herlong, H. Franklin ; Gurakar, Ahmet ; Li, Zhiping ; Koteish, Ayman A. ; Bridges, John F P ; Pawlik, Timothy M. / Clinical decision-making by gastroenterologists and hepatologists for patients with early hepatocellular carcinoma. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 6. pp. 1844-1851.
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AU - Pawlik, Timothy M.

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N2 - Background: Choice of therapy in early hepatocellular carcinoma (HCC) is controversial, and no broad consensus exists as to how patient and tumor characteristics should be used to guide choice of therapy. We have previously reported on decision making in early HCC by liver surgeons. In the present study, we quantified the impact of clinical factors on choice of therapy for early HCC by gastroenterologists and hepatologists. Methods: Physicians who treat HCC were invited to complete a web-based survey including ten case scenarios that systematically varied across seven clinical factors. Choice of therapy - liver transplantation (LT), liver resection (LR), radiofrequency ablation or intra-arterial therapy - was analyzed using multinomial logistic regression models. Results: Tumor number and size, type of resection required, biological Model for End-Stage Liver Disease (MELD) score, and platelet count had the largest effects on choice of therapy. For example, LR was more likely to be recommended over LT for patients with small solitary tumors versus multiple tumors [relative risk ratio (RRR) 3.63], those who would require a minor versus major LR (RRR 3.39), those with lower biological MELD score (6 vs. 10; RRR 1.95), and those with a higher platelet count (150,000/μL vs. 70,000/μL; RRR 2.77). In contrast, serum α-fetoprotein level and etiology of cirrhosis were not associated with choice of therapy. No physician-related factors studied had an impact on choice of therapy. Conclusion: The clinical factors weighed most heavily by gastroenterologists and hepatologists are quite similar to those considered important by surgeons. There was good consensus among gastroenterologists and hepatologists as to the factors used to choose therapy.

AB - Background: Choice of therapy in early hepatocellular carcinoma (HCC) is controversial, and no broad consensus exists as to how patient and tumor characteristics should be used to guide choice of therapy. We have previously reported on decision making in early HCC by liver surgeons. In the present study, we quantified the impact of clinical factors on choice of therapy for early HCC by gastroenterologists and hepatologists. Methods: Physicians who treat HCC were invited to complete a web-based survey including ten case scenarios that systematically varied across seven clinical factors. Choice of therapy - liver transplantation (LT), liver resection (LR), radiofrequency ablation or intra-arterial therapy - was analyzed using multinomial logistic regression models. Results: Tumor number and size, type of resection required, biological Model for End-Stage Liver Disease (MELD) score, and platelet count had the largest effects on choice of therapy. For example, LR was more likely to be recommended over LT for patients with small solitary tumors versus multiple tumors [relative risk ratio (RRR) 3.63], those who would require a minor versus major LR (RRR 3.39), those with lower biological MELD score (6 vs. 10; RRR 1.95), and those with a higher platelet count (150,000/μL vs. 70,000/μL; RRR 2.77). In contrast, serum α-fetoprotein level and etiology of cirrhosis were not associated with choice of therapy. No physician-related factors studied had an impact on choice of therapy. Conclusion: The clinical factors weighed most heavily by gastroenterologists and hepatologists are quite similar to those considered important by surgeons. There was good consensus among gastroenterologists and hepatologists as to the factors used to choose therapy.

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