Understanding surgical decision making in early hepatocellular carcinoma

Hari Nathan, John F P Bridges, Richard D. Schulick, Andrew M. Cameron, Kenzo Hirose, Barish H. Edil, Christopher L. Wolfgang, Dorry L. Segev, Michael A. Choti, Timothy M. Pawlik

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Purpose: The choice between liver transplantation (LT), liver resection (LR), and radiofrequency ablation (RFA) as initial therapy for early hepatocellular carcinoma (HCC) is controversial, yet little is known about how surgeons choose therapy for individual patients. We sought to quantify the impact of both clinical factors and surgeon specialty on surgical decision making in early HCC by using conjoint analysis. Methods: Surgeons with an interest in liver surgery were invited to complete a Web-based survey including 10 case scenarios. Choice of therapy was then analyzed by using regression models that included both clinical factors and surgeon specialty (non-LT v LT). Results: When assessing early HCC occurrences, non-LT surgeons (50% LR; 41% LT; 9% RFA) made significantly different recommendations compared with LT surgeons (63% LT; 31% LR; 6% RFA; P < .001). Clinical factors, including tumor number and size, type of resection required, and platelet count, had significant effects on the choice between LR, LT, and RFA. After adjusting for clinical factors, non-LT surgeons remained more likely than LT surgeons to choose LR compared with LT (relative risk ratio [RRR], 2.67). When the weight of each clinical factor was allowed to vary by surgeon specialty, the residual independent effect of surgeon specialty on the decision between LR and LT was negligible (RRR, 0.93). Conclusion: The impact of surgeon specialty on choice of therapy for early HCC is stronger than that of some clinical factors. However, the influence of surgeon specialty does not merely reflect an across-the-board preference for one therapy over another. Rather, certain clinical factors are weighed differently by surgeons in different specialties.

Original languageEnglish (US)
Pages (from-to)619-625
Number of pages7
JournalJournal of Clinical Oncology
Volume29
Issue number6
DOIs
StatePublished - Feb 20 2011

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Hepatocellular Carcinoma
Decision Making
Liver Transplantation
Liver
Transplantation
Surgeons
Odds Ratio
Surgical Specialties
Therapeutics
Platelet Count
Weights and Measures

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Nathan, H., Bridges, J. F. P., Schulick, R. D., Cameron, A. M., Hirose, K., Edil, B. H., ... Pawlik, T. M. (2011). Understanding surgical decision making in early hepatocellular carcinoma. Journal of Clinical Oncology, 29(6), 619-625. https://doi.org/10.1200/JCO.2010.30.8650

Understanding surgical decision making in early hepatocellular carcinoma. / Nathan, Hari; Bridges, John F P; Schulick, Richard D.; Cameron, Andrew M.; Hirose, Kenzo; Edil, Barish H.; Wolfgang, Christopher L.; Segev, Dorry L.; Choti, Michael A.; Pawlik, Timothy M.

In: Journal of Clinical Oncology, Vol. 29, No. 6, 20.02.2011, p. 619-625.

Research output: Contribution to journalArticle

Nathan, H, Bridges, JFP, Schulick, RD, Cameron, AM, Hirose, K, Edil, BH, Wolfgang, CL, Segev, DL, Choti, MA & Pawlik, TM 2011, 'Understanding surgical decision making in early hepatocellular carcinoma', Journal of Clinical Oncology, vol. 29, no. 6, pp. 619-625. https://doi.org/10.1200/JCO.2010.30.8650
Nathan H, Bridges JFP, Schulick RD, Cameron AM, Hirose K, Edil BH et al. Understanding surgical decision making in early hepatocellular carcinoma. Journal of Clinical Oncology. 2011 Feb 20;29(6):619-625. https://doi.org/10.1200/JCO.2010.30.8650
Nathan, Hari ; Bridges, John F P ; Schulick, Richard D. ; Cameron, Andrew M. ; Hirose, Kenzo ; Edil, Barish H. ; Wolfgang, Christopher L. ; Segev, Dorry L. ; Choti, Michael A. ; Pawlik, Timothy M. / Understanding surgical decision making in early hepatocellular carcinoma. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 6. pp. 619-625.
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