Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California,USA.
Hepatol Commun. 2023 Apr 26;7(5). doi: 10.1097/HC9.0000000000000143. eCollection 2023 May 1.
Given the complexity of managing HCC, professional society guidelines advocate multidisciplinary care (MDC) for patients with HCC. However, implementation of MDC programs requires a significant investment of time and resources. We conducted a systematic review and meta-analysis to enumerate potential benefits of MDC for patients with HCC.
We conducted a search of the PubMed/MEDLINE and EMBASE databases and national conference abstracts to identify studies published after January 2005 that reported early-stage presentation, treatment receipt, or overall survival among patients with HCC, stratified by MDC status. We calculated pooled risk ratios and HRs for clinical outcomes according to MDC receipt using the DerSimonian and Laird method for random effects models.
We identified 12 studies (n = 15,365 patients with HCC) with outcomes stratified by MDC status. MDC was associated with improved overall survival (HR = 0.63, 95% CI: 0.45-0.88); however, its association with curative treatment receipt was not statistically significant (risk ratio = 1.60, 95% CI: 0.89-2.89) and pooled estimates were limited by high heterogeneity (I2 > 90% for both). Studies (n = 3) were discordant regarding an association between MDC and time-to-treatment initiation. MDC was associated with early-stage HCC (risk ratio = 1.60, 95% CI: 1.12-2.29), suggesting possible referral bias contributing to improved outcomes. Limitations of studies also included risk of residual confounding, loss to follow-up, and data preceding the availability of immune checkpoint inhibitors.
MDC for patients with HCC is associated with improved overall survival, underscoring the likely benefit of managing patients with HCC in a multidisciplinary care setting.
鉴于 HCC 管理的复杂性，专业学会指南主张对 HCC 患者进行多学科治疗（MDC）。然而，实施 MDC 计划需要大量的时间和资源投入。我们进行了系统评价和荟萃分析，以列举 MDC 对 HCC 患者的潜在益处。
我们对 PubMed/MEDLINE 和 EMBASE 数据库以及国家会议摘要进行了检索，以确定自 2005 年 1 月以来发表的报告 HCC 患者早期表现、治疗接受情况或总生存率，并按 MDC 状态进行分层的研究。我们使用随机效应模型的 DerSimonian 和 Laird 方法，根据 MDC 接受情况计算临床结局的汇总风险比和 HR。
我们确定了 12 项研究（n = 15365 例 HCC 患者），其结局按 MDC 状态进行分层。MDC 与总生存率提高相关（HR = 0.63，95%CI：0.45-0.88）；然而，其与根治性治疗接受情况的关联不具有统计学意义（风险比 = 1.60，95%CI：0.89-2.89），并且汇总估计受到高度异质性的限制（两者的 I2 > 90%）。研究（n = 3）对 MDC 与治疗开始时间之间的关联存在分歧。MDC 与早期 HCC 相关（风险比 = 1.60，95%CI：1.12-2.29），表明可能存在转诊偏见导致结局改善。研究的局限性还包括残留混杂因素的风险、失访以及免疫检查点抑制剂可用之前的数据。
MDC 对 HCC 患者与总体生存率提高相关，强调了在多学科治疗环境中管理 HCC 患者的可能益处。
