A Multi-Disciplinary Team Approach Optimizes Therapy Selections and Improves Survival Outcomes in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus

A Multi-Disciplinary Team Approach Optimizes Therapy Selections and Improves Survival Outcomes in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus

1. Abstract
1.1. Background: The treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) is complicated and requires a coordinated multidisciplinary approach. The impact of a multidisciplinary team (MDT) approach on selecting therapies and long-time survivals of patients with HCC with PVTT is retrospectively studied.
1.2. Methods: The clinical and survival data of patients with HCC and PVTT who were managed before (April 2007- March 2013) and after (April 2013-September 2020) the establishment of an MDT were retrospectively compared.
1.3. Results: Of 1906 patients included, 1094 were in the MDT-group and 812 in the pre-MDT group. After introducing an MDT procedure, the proportions of patients who underwent surgical resection (34.6% vs. 29.3%, p = 0.014) and received molecularly targeted drugs (19.4% vs. 7.8%, p = 0.00), were significantly increased. Patients managed through the MDT approach had a significantly improved survival compared with who didn’t (13.5 vs. 11.5 months, p = 0.00). After stratification with treatment modalities, the MDT procedure significantly improved survival in patients received surgery (16.3 vs. 13.9 months, p = 0.038), while marginally increased survival in patients had non-curative local treatments (11.8 vs. 11.0 months, p = 0.064). The implementation of an MDT significantly reduced long-term HCC-related deaths, with a hazard ratio (HR) of 0.78 (95% Confidential Interval, 0.70–0.86, p = 0.00).