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

OBJECTIVE: 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. SUMMARY OF BACKGROUND DATA: MDTs are essential in cancer care and recommended prior to therapy initiation. However, data on adherence to MDT recommendations remain limited. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.