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Management and patient survival in hepatocellular carcinoma: Does the physician's level of experience matter?
Author(s) -
Chen TsungMing,
Chang TzuMing,
Huang PiTeh,
Tsai MingHung,
Lin LienFu,
Liu ChungCheng,
Ho KaSic,
Siauw ChuanPau,
Chao PoLiang,
Tung JaiNien
Publication year - 2008
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2008.05341.x
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , confidence interval , ascites , gastroenterology , stage (stratigraphy) , multivariate analysis , liver function , cirrhosis , liver cancer , paleontology , biology
The prognostic determinants of hepatocellular carcinoma (HCC) depend on tumor stage, liver function reserve, and treatments offered. The clinical impact of the physician's experience on HCC management and the survival outcome is unknown. Methods: A total of 103 patients were managed by one high‐volume physician and 249 patients by seven low‐volume physicians. The experience of high‐volume physician in HCC management was five times more than that of low‐volume physicians. Patient survival was the single end point for this study. Results: Compared to the low‐volume physician group, more of the patients allocated to the high‐volume physician had early stage HCC on the date of diagnosis (66/103, 64.1%; vs 119/249, 47.8%; P = 0.008), and they received curative therapies including radiofrequency ablation or liver resection (66/103, 64.1% vs 54/249, 21.7%, P < 0.001), and had significantly better survival outcome (median survival of 34 months, 95% confidence interval [CI], 17.6–50.4; vs 6 months, 95% CI, 4.3–7.7; P < 0.001) with a multivariable‐adjusted hazard ratio (HR) for survival of 1.94 (95%, CI, 1.31–2.87, P < 0.001). A multivariate analysis of the pretreatment prognostic factors for these two groups identified α‐fetoprotein (AFP) level (HR, 1.42; 95% CI, 1.01–1.99; P = 0.042), ascites (HR, 1.68; 95% CI, 1.15–2.46; P = 0.007), maximum tumor diameter (HR, 1.78; 95% CI, 1.16–2.74; P = 0.009), and portal vein thrombosis (PVT) (HR, 2.17; 95% CI, 1.49–3.17; P < 0.001) as independent factors for the low‐volume physician group. However, only maximum tumor diameter (HR, 4.54; 95% CI, 1.77–11.67; P < 0.001) and PVT (HR, 5.73; 95% CI, 2.30–14.22; P = 0.002) were independent factors for the high‐volume physician group. Conclusion: The survival of HCC patients was dependent on the level of experience of the physicians who oversaw these patients.