Specialist referral patterns and relationship to outcomes in patients with hepatocellular carcinoma.

Abstract

e16242 Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of cancer-related mortality, with a 5-year survival rate of approximately 20%. Management includes an interdisciplinary approach, involving medical oncologists, gastroenterologists, radiation oncologists, and surgeons. Early recognition and referral to a multi-disciplinary team is proven to improve survival rates. However, it is unclear if a first referral to and primary management by a particular subspecialist is associated with better or worse clinical outcomes. Methods: A retrospective study of patients aged > 18 years with HCC diagnosed at Sidney Kimmel Comprehensive Cancer Center (Greater Philadelphia Area) in 2021-2024 was conducted. Data on patient and tumor characteristics at the time of diagnosis, transplant and treatment eligibility were collected for analysis. Survival was monitored at annual intervals starting from one year to five years after diagnosis, or as time to first event from diagnosis. Patients were divided into subgroups depending on the first specialist seen. Results: Data from 433 patients (78% male, mean age at diagnosis: 65.5 years) were included. Thirty-eight percent had stage 3 or 4 disease. The majority had Class 0 (32.2%) or A (34.5%) disease per BCLC, while a smaller proportion had advanced disease of Class B (17.8%), C (10.9%), and D (4.6%). Most commonly seen first specialist was gastroenterologist (61%), followed by medical oncologist (15%), interventional radiologist (IR) (8.7%), surgeon (6.2%), and multidisciplinary teams (3.5%). Most common initial treatments were locoregional (58%), surgery (15.5%), systemic treatment (13%), transplant (4.5%), while 5.5% were not treatment eligible. The mean survival time for patients who followed up first with medical oncologist was 28.9 months (95% CI: 13-36 months), while for IR, surgeon, and gastroenterologist, it was 51.8 months (95% CI: 47-82 months), 48.1 months (95% CI: 46-56 months), and 46.0 months (95% CI: 44-54 months), respectively (p < 0.005). These differences disappeared after adjusting for BCLC staging. Importantly, medical oncologists saw patients with more advanced stages (32%) compared to other specialists (vs 8% surgery, vs 23% IR, vs 10% gastroenterologist). Conclusions: This analysis demonstrates differences in survival rates depending on the first specialist seen by patients with HCC. Patients seen first by a medical oncologist tended to have a more advanced stage of disease compared to individuals seen by gastroenterologists, interventional radiologists, or surgeons. This difference may, however, also reflect suboptimal utilization of multidisciplinary care and warrants further investigation.