Chemoembolization of hepatocellular carcinoma: patient status at presentation and outcome over 15 years at a single center.

OBJECTIVE: We report the outcome of the care of 209 patients with hepatocellular carcinoma with a focus on relevant scoring systems for predicting overall survival and time to progression and on changes in presentation status and outcome from 1991 to 2006. MATERIALS AND METHODS: Hepatic arterial chemoembolization was performed on 209 patients in 375 sessions. Disease status was evaluated with the Child-Pugh, Okuda, Cancer of the Liver Italian Program, and American Joint Committee on Cancer (AJCC) systems. Changes in status at presentation from 1991 to 2006 and change in overall survival period and time to progression were analyzed. RESULTS: Median and mean overall survival periods for the entire group were 376 and 574 +/- 61 days. Median and mean times to progression were 267 and 409 +/- 54 days. Forty-nine patients underwent liver transplantation a median of 143 days after chemoembolization. The median and mean overall survival times among patients not undergoing transplantations were 466 and 574 +/- 61 days. Okuda score (p < 0.0001) and AJCC stage (p = 0.014) were the best predictors of overall survival and time to progression, respectively. Patients with disease with an Okuda I score and in AJCC stage I or II had median and mean overall survival periods of 667 and 992 +/- 176 days and times to progression of 378 and 589 +/- 110 days. Clinical status at presentation, overall survival period (p = 0.64), and time to progression (p = 0.44) were unchanged from 1991 to 2006. The 30-day mortality was 3.2%. CONCLUSION: Patients treated with hepatic arterial chemoembolization for HCC in Okuda score I and AJCC stage I or II have more durable survival than previously reported in a U.S. population.

Costs of a medical education: comparison with graduate education in law and business.

INTRODUCTION: The costs of graduate school education are climbing, particularly within the fields of medicine, law, and business. METHODS: Data on graduate level tuition, educational debt, and starting salaries for medical school, law school, and business school graduates were collected directly from universities and from a wide range of published reports and surveys. RESULTS: Medical school tuition and educational debt levels have risen faster than the rate of inflation over the past decade. Medical school graduates have longer training periods and lower starting salaries than law school and business school graduates, although physician salaries rise after completion of post-graduate education. CONCLUSIONS: Faced with an early debt burden and delayed entry into the work force, careful planning is required for medical school graduates to pay off their loans and save for retirement.

Retirement savings plans for radiologists: part 1--the options.

Employer-sponsored retirement plans are the primary savings vehicles used by radiologists to fund their retirements. A variety of retirement plans are available with guidelines, benefits, and restrictions specified by the Internal Revenue Code. In this article, we review and summarize the salient features of these plans. A second article, in an upcoming issue of JACR, explores the current status of radiologists' retirement plans.

Retirement savings plans for radiologists, part 2: a comparison of academic and private practice retirement benefits.

A survey on retirement benefits was conducted involving 42 academic radiology departments and 42 private practice radiology groups. In this article, we present and discuss the survey results and provide recommendations for improving the retirement benefits for radiologists in both private practice and academic settings. A previous article, in last month's issue, provides details of how the various retirement plans mentioned in this article operate.