Adherence to Multidisciplinary Tumor Board Decisions Determines Long-term Survival in Patients with Hepatocellular Carcinoma.

Abstract

This study evaluated the impact of adherence to hepatobiliary multidisciplinary tumorboard (MDT) recommendations on patient outcomes, summarizing reasons for non-adherence and estimating its effect on survival. MDTs are essential in cancer care and recommended prior to therapy initiation. However, data on adherence to MDT recommendations remain limited. This retrospective single-center study analyzed hepatocellular carcinoma (HCC) cases presented at the hepatobiliary MDT at Charité - Universitätsmedizin Berlin between 2014 and 2018. Data were obtained from chart reviews and the clinical cancer registry. Adherence to MDT recommendations was classified as major, minor or non-adherent. 2,104 conference cases from 879 patients with HCC were assessed. Treatment adherence was noted in 82.7% of presented cases. Overall patient-based adherence was 90.2%, with 72.2% major and 18.0% minor adherence. Median Overall survival (mOS) was significantly longer when MDT recommendations were followed (adherent: mOS 4.7 years, 95% CI: 4.5-5.9; minor adherence: 3.1 years, 95% CI: 2.15-NA; non-adherence: 1.5 years, 95% CI: 0.8-3.1; P<0.001). Reasons for MDT deviations were mainly comorbidities (29.5%), tumor progression (24%), patient preference (13.1%) or individual physician decisions (9.3%). Within the non-adherence group, both patient preferences (mOS: NA; 95% CI: 6.79-NA) and physician decisions (mOS: 4.30 y; 95% CI: 1.37-NA) were associated with comparatively longer mOS. Adherence to MDT recommendations is associated with improved long-term survival for HCC patients. Notably, beyond tumor-related factors, patient preferences and physician decisions contributed to longer mOS and should be highly respected in selected cases.