Multidisciplinary Team Model Of Management Of Hepatocellular Carcinoma And Related Principles For Implementation

BackgroundHepatocellular carcinoma(HCC)is a disease of high morbidity and extremely poor prognosis in China.Departments in hospital that treat HCC are facing a dilemma of overlapping indication of techniques,insufficient cooperation and lacking of unitive guidelines,and this situation leads to inferior prognosis in patients with HCC.To solve the challenge and to improve prognosis of HCC,Multidisciplinary Team(MDT)model should be initiated which is recommended by almost every current guidelines and consensuses.However,in China,MDT is yet less acknowledged.There are few data that illustrate how MDT could benefit clinical outcome of HCC as well as hospitals and departments themselves.And there are few consensuses explain how to manage MDT model technically and theoretically.This paper discussed the issues mentioned above based on practical MDT experience for HCC from a long period which is rare in China.ObjectiveThis paper was to illustrate the dilemma of treating HCC in China,and how MDT would solve this problem with domestic and overseas evidence.It also aimed to analysis prognostic factors on patients with HCC who underwent MDT in our hospital.This paper also discussed how to manage MDT model technically and theoretically.Finally,a new promising model of internet plus MDT(eMDT)was discussed.MethodsChapter 1 discussed advantages of MDT model in HCC with domestic and overseas evidence collected.Chapter 2 introduced a cohort study.This retrospective study enrolled 132 HBsAg positive patients with HCC who underwent MDT at our hospital between 1st January 2015 and 31st December 2015,and all patients were followed up to 31st December 2017.Patients were divided into various groups based on Barcelona Clinic Liver Cancer(BCLC)system,combination therapy and compliance with MDT suggestion,etc.Overall survival(OS)and time to progress(TTP)were reviewed.Chapter 3 and 4 discussed three dimentional theory of MDT principle and practical experience of implementation of MDT which were both essential for whom would iniciate MDT model.A creative idea to improve MDT model was also brought up.Results1.MDT model would benefit patients,hospitals,and departments in various levels.2.Compliance with MDT suggestion was a prognostic factor on OS(?2=44.062,P<0.05).Combination therapy was an independent prognostic factor on OS(HR=0.451;95%CI 0.210-0.968).Median OS(mOS)of patients who complied with MDT suggestion and received combination therapy simultaneously was 29.4 mos,whereas that of patients who under the exactly opposite situation was 17.0 mos(?2=13.336,P<0.001).Combination therapy was also a prognostic factor on TTP(?2=7.263,P<0.05).3.Experts that participate MDT should discuss and make decision on the basis of three principles avoiding excessive and inappropriate debate,and MDT model should be operated according to standard and experience concluded.Virtual MDT(vMDT)would improve MDT model.ConclusionsMDT model would improve prognosis of HCC.Improvement of compliance with MDT suggestion and combination therapy could probably improve prognosis of HCC after MDT.Implementation of MDT should apply to some standard and there were technical and theoretical experience.Internet plus MDT(eMDT)would improve MDT model.