Effectiveness of an interdisciplinary approach to early diagnosis of hepatocellular carcinoma

The implementation in the Republic of Sakha (Yakutia) of a set of measures aimed at eliminating parenteral viral hepatitis and improving the provision of medical care to the adult population with oncological diseases has had a significant impact on the effectiveness of hepatocellular carcinoma diagnosis. Patients with advanced fibrosis and cirrhosis of the liver require special attention, as it is in this group of patients that the highest proportion of fatalities is observed, as well as the greatest burden on the healthcare system budget. The aim of the study was to evaluate the impact of an interdisciplinary approach on the etiological verification of the diagnosis and the effectiveness of HCC detection using the example of the Republic of Sakha (Yakutia). The article presents a retrospective analysis was conducted of data from 632 patients with HCC in the Republic of Sakha (Yakutia) who were examined and treated at the Yakutsk Republican Oncology Dispensary, and an analysis of the incidence rate based on official statistics before and after the introduction of the interdisciplinary approach. Due to improved screening, the proportion of patients with viral hepatitis markers increased 2.5 times and approached 70%. Clinical and laboratory diagnosis of liver cirrhosis improved, which is extremely important when choosing a treatment strategy for a patient. The rate of early diagnosis at stage I according to the TNM classification increased from 5.1% to 12.0% over 5 years. The increase in the proportion of patients with early-stage HCC opens up broad opportunities for the use of local tumor destruction methods and is expected to increase the overall survival of patients. It has been shown that an interdisciplinary approach reduces the time it takes to refer a patient from an infectious disease specialist to an oncologist and improves the quality of morphofunctional diagnosis of the liver. The experience of the Republic of Sakha (Yakutia) shows that improving dispensary observation of risk groups and continuity in patient management within the framework of interdisciplinary cooperation between specialists is a promising direction that can ensure early diagnosis of HCC and improve treatment outcomes.

1. Hepatitis C disease burden in the Russian Federation: from the real-life situation to strategy. / V.P. Chulanov, V.N. Gorodin, O.I. Sagalova [el al.] // Infectious diseases. 2021; 19(4): 52–63. (In Russ.). doi: 10.20953/1729-9225-2021-4-52-63.

2. Impact of a multidisciplinary approach and patient routing on the outcomes of treatment of patients with hepatocellular cancer / V.V. Petkau, E.N. Bessonova, V.V. Breder [et al.] // Malignant tumours. 2023;13(2):5-11. (In Russ.) doi:10.18027/2224-5057-2023-13-2-1.

3. Hepatocellular cancer of non-viral etiology: more questions than answers? / V.V. Breder, I.A. Pokataev, O. Abdelgafur [et al.] // Medical alphabet. 2022; (26): 7-12. doi: 10.33667/2078-5631-2022-26-7-12.

4. Malignant neoplasms in Russia in 2019 (morbidity and mortality). Kaprin A.D., Starinsky V.V., Shakhzadova A.O., editors. Moscow: P.A. Herzen Moscow Research Institute of Oncology (P.A. Herzen Moscow Research Institute of Oncology) - a branch of the National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation.; 2020. 252 р.

5. Malignant neoplasms in Russia in 2023 (morbidity and mortality). Kaprin A.D., Starinsky V.V., Shakhzadova A.O., editors. Moscow: P.A. Herzen Moscow Research Institute of Oncology (P.A. Herzen Moscow Research Institute of Oncology) - a branch of the National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation. 2024. 252 с.

6. Kalinin A.E., Guschin V.V. Multidisciplinary team discussion in onсology. City Healthcare. 2020; 1(1): 108-111. DOI: 10.47619/2713-2617.zm.2020.v1i1;108-111.

7. Multidisciplinary approach in hepatocellular carcinoma progression treatment after liver transplantation: the first experience in Russia. / O.D. Olisov, I.A. Dzhanyan, M.S. Novruzbekov [et al.] // Annals of HPB Surgery. 2019; 24(4): 65-73. DOI: 10.16931/1995-5464.2019465-73.

8. Search for effective serum tumor markers for early diagnosis of hepatocellular carcinoma associated with hepatitis C. / S.I. Malov, I.V. Malov, A.G. Kuvshinov [et al.] // Modern technologies in medicine. 2021; 13(1): 27-34. DOI: 10.17691/stm2021.13.1.03.

9. Shveykin A.O., Kanner D. Yu. Role of multidisciplinary team in management of unresectable HCC: Opportunities that exist today. Medical alphabet. 2023; (17): 17-21. DOI: 10.33667/2078-5631-2023-17-17-21.

10. Cabibbo G., Singal A.G. The quest for precision oncology with immune checkpoint inhibitors for hepatocellular carcinoma. J Hepatol. 2022; 76(2): 262-264. DOI: 10.1016/j.jhep.2021.11.021.

11. Calvaruso V., Cabibbo G., Cacciola I., et al. Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents. Gastroenterol. 2018; 155(2): 411-421. doi: 10.1053/j.gastro.2018.04.008.

12. Llovet J.M., Kelley R.K., Villanueva A., et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021; 7(1): 6. doi: 10.1038/s41572-020-00240-3.

13. Russo F.P., Zanetto A., Pinto E., et al. Hepatocellular carcinoma in chronic viral hepatitis: Where do we stand? Int J Mol Sci. 2022; 23(1): 500. doi: 10.3390/ijms23010500.

14. Singal A.G., Kanwal F., Llovet J.M. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nat Rev Clin Oncol. 2023; 20(12): 864-884. doi: 10.1038/s41571-023-00825-3.

15. Tani J, Morishita A, Sakamoto T, et al. Simple scoring system for prediction of hepatocellular carcinoma occurrence after hepatitis C virus eradication by direct-acting antiviral treatment: All Kagawa Liver Disease Group Study. Oncol Lett. 2020; 19(2): 2205-2212. https://doi.org/10.3892/ol.2020.11341.

16. Tsuchiya N, Sawada Y, Endo I, el al. Biomarkers for the early diagnosis of hepatocellular carcinoma. World J Gastroenterol. 2015; 21(37): 10573-10583. DOI: 10.3748/wjg.v21.i37.10573.

17. Virlogeux V., Pradat P., Hartig-Lavie K. Direct-acting antiviral therapy decreases hepatocellular carcinoma recurrence rate in cirrhotic patients with chronic hepatitis C. Liver Int. 2017; 37(8): 1122-1127. doi: 10.1111/liv.13456.

18. Zeng Z, Liu H, Xu H, et al. Genome-wide association study identifies new loci associated with risk of HBV infection and disease progression. BMC Med Genomics. 2021; 14(1): 84. doi: 10.1186/s12920-021-00907-0.