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<p>Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are among those primary liver tumors with the worst prognoses. Due to their biological complexity, the frequently impaired liver function, and the broad spectrum of therapeutic options, these tumors require a&#xa0;consistent multidisciplinary treatment strategy. In this context, the multidisciplinary tumor board (MTB) is not only an organizational instrument but also a&#xa0;medical necessity that is firmly anchored as a&#xa0;standard of care in all relevant international guidelines. For HCC, the therapeutic spectrum of the MTB encompasses curative strategies in early stages—resection, liver transplant, and thermal ablation—as well as locoregional treatments for intermediate stages, particularly transarterial chemoembolization (TACE), radioembolization with <sup>90</sup>Yttrium (<sup>90</sup>Y), and stereotactic body radiation. The latter has significant advantages for lesions close to vessels or the diaphragm as well as in patients with portal vein thromboses, and it complements the spectrum of interventional options in combination with TACE. In advanced stages, immune checkpoint-based combination therapy—particularly atezolizumab plus bevacizumab (IMbrave150) as well as tremelimumab plus durvalumab (HIMALAYA)—has fundamentally changed systemic first-line therapy and improved median overall survival to up to 19&#xa0;months. The evidence supporting the importance of the MTB in HCC is convincing: patients discussed in the MTB were diagnosed in earlier stages, received more timely treatment, and had improved 5‑year survival rates (up to 71% compared to 59% without MTB presentation). For CCA, in addition to R0&#xa0;resection as the only curative approach, the integration of molecular diagnostics—particularly next-generation sequencing (NGS)-based profiling for <i>FGFR2</i>, <i>IDH1</i>, and <i>HER2</i> alterations—is a&#xa0;central task of the MTB. Establishment of the indication for neoadjuvant chemotherapy in tumors with borderline resectability, the coordination of locoregional treatments, and selection for transplant protocols among highly selected patients represent further MTB decisions. In summary, the current evidence indicates that optimal oncological outcomes are only achievable in HCC and CCA via the seamless integration of all relevant disciplines in the MTB. The referral of patients to tertiary centers with established hepatobiliary MTB structures should be a&#xa0;mandatory quality standard.</p>

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Bedeutung des Multidisziplinären Tumorboards in der Behandlung des hepatozellulären Karzinoms und des cholangiozellulären Karzinoms

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月31日

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  • Jörg Lehner,
  • Thomas B. Brunner

摘要

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are among those primary liver tumors with the worst prognoses. Due to their biological complexity, the frequently impaired liver function, and the broad spectrum of therapeutic options, these tumors require a consistent multidisciplinary treatment strategy. In this context, the multidisciplinary tumor board (MTB) is not only an organizational instrument but also a medical necessity that is firmly anchored as a standard of care in all relevant international guidelines. For HCC, the therapeutic spectrum of the MTB encompasses curative strategies in early stages—resection, liver transplant, and thermal ablation—as well as locoregional treatments for intermediate stages, particularly transarterial chemoembolization (TACE), radioembolization with 90Yttrium (90Y), and stereotactic body radiation. The latter has significant advantages for lesions close to vessels or the diaphragm as well as in patients with portal vein thromboses, and it complements the spectrum of interventional options in combination with TACE. In advanced stages, immune checkpoint-based combination therapy—particularly atezolizumab plus bevacizumab (IMbrave150) as well as tremelimumab plus durvalumab (HIMALAYA)—has fundamentally changed systemic first-line therapy and improved median overall survival to up to 19 months. The evidence supporting the importance of the MTB in HCC is convincing: patients discussed in the MTB were diagnosed in earlier stages, received more timely treatment, and had improved 5‑year survival rates (up to 71% compared to 59% without MTB presentation). For CCA, in addition to R0 resection as the only curative approach, the integration of molecular diagnostics—particularly next-generation sequencing (NGS)-based profiling for FGFR2, IDH1, and HER2 alterations—is a central task of the MTB. Establishment of the indication for neoadjuvant chemotherapy in tumors with borderline resectability, the coordination of locoregional treatments, and selection for transplant protocols among highly selected patients represent further MTB decisions. In summary, the current evidence indicates that optimal oncological outcomes are only achievable in HCC and CCA via the seamless integration of all relevant disciplines in the MTB. The referral of patients to tertiary centers with established hepatobiliary MTB structures should be a mandatory quality standard.