Date of Award

1-1-2023

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Tamar H. Taddei

Abstract

Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board’s recommended treatment. In this paper, we performed a single-site, retrospective cohort study of patients with HCC who were evaluated by an MDLTB. We examined adherence to the MDLTB’s recommendations and in cases of discordant treatment, evaluated the underlying cause. We found that most patients’ therapies were adherent to the MDLTB’s recommendation and that most non-adherence was unavoidable. The majority of discordant treatment choices were made for patients with stage A unifocal disease. We therefore compared overall survival time of different treatment choices within this group and found that patients treated with curative (resection or ablation) as opposed to palliative (transarterial) locoregional therapy had significantly longer survival time. We also assessed whether the board’s recommendation and the treatment actually received were compliant with the contemporaneous Barcelona-Clinic Liver Cancer (BCLC) 2012 classification, and also whether they were compliant with the current (2022) BCLC classification. We found 92% of recommendations were compliant with the 2012 guideline, and 88% were compliant with the 2022 guideline. While MDLTBs are widely recognized as important in HCC management, prospective study of their treatment recommendations requires standardized metrics for implementation and outcomes evaluation.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/30/2025

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