Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Department of Internal Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia.
J Surg Oncol. 2019 Dec;120(8):1365-1370. doi: 10.1002/jso.25738. Epub 2019 Oct 22.
Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety-net hospitals is unknown.
Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined.
Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver-directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001).
Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.
在美国多学科疾病管理团队（DMT）中，丙型肝炎（HCV）是肝细胞癌（HCC）的主要病因，这些团队优化了肿瘤治疗。安全网医院中 DMT 对 HCC 的影响尚不清楚。
纳入 2009 年至 2016 年在 Grady Memorial Hospital（GMH）诊断为 HCC 的患者。主要目的是评估 DMT 形成后对治疗的转介、接受治疗和总生存期（OS）。还检查了 HCV 患者 HCC 的筛查模式。
在 204 名 HCC 患者中，中位年龄为 58 岁，男性占 81%，黑人占 83%。46%的患者为 4 期疾病，53%的患者接受治疗，中位 OS 为 9.8 个月。DMT 的形成与手术转诊（49%比 30%；P=.02）、肝定向治疗（58%比 31%；P=.001）和放疗（13%比 3%；P=.019）的增加有关。患者也更有可能接受治疗（59%比 41%；P=.026），中位 OS 也有所改善（30.7 比 4.9 个月；P<.001）。DMT 并未改变 HCC 的 HCV 筛查（23%）。接受 HCC 筛查的 HCV 患者疾病分期更早（P=.001）。
在 GMH 实施 DMT 与增加 HCC 患者接受治疗的转诊/接受治疗的比例以及提高生存率有关。尽管有 DMT，但很少有 HCV 高危 HCC 患者接受筛查。未来的努力应旨在为高危 HCC 的 HCV 患者建立筛查计划。
