Michael J Magnetta1, Minzhi Xing2, Di Zhang3, Hyun S Kim4. 1. Departments of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania. 2. Division of Interventional Radiology, Department of Radiology, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT 06510. 3. Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania. 4. Departments of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Interventional Radiology, Department of Radiology, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT 06510; Yale Cancer Center, New Haven, Connecticut.. Electronic address: kevin.kim@yale.edu.
Abstract
PURPOSE: To investigate socioeconomic and demographic factors associated with transplantation outcomes in patients with hepatocellular carcinoma (HCC) treated with bridging locoregional therapy (LRT) before orthotopic liver transplantation (OLT). MATERIALS AND METHODS: The United Network for Organ Sharing (UNOS) database was used to identify all patients in the United States with HCC who were listed for OLT between 2002 and 2013. Mean overall survival (OS) after OLT was stratified based on age, sex, ethnicity, transplant year, region, and insurance status. Kaplan-Meier estimation was used for survival analysis with log-rank test and Cox proportional hazards model to assess independent prognostic factors for OS. RESULTS: Of the 17,291 listed patients with HCC, 14,511 underwent OLT. Mean age was 57.4 years (76.8% male). Favorable sociodemographic factors were associated with increased rates of bridging LRT before OLT and longer wait time on the transplant list and were shown to be independent prognostic factors for prolonged OS after OLT using multivariate analysis. Favorable demographic factors included patient age < 60 years, donor age < 45 years, year of diagnosis between 2008 and 2013, UNOS regions 4 and 5, Asian ethnicity, high functional status, postgraduate education, private payer insurance, and employment at the time of OLT. CONCLUSIONS: Patients with favorable sociodemographics had higher rates of LRT before OLT performed for HCC cure. These patients had longer transplant wait times and longer OS after OLT. Copyright Â
PURPOSE: To investigate socioeconomic and demographic factors associated with transplantation outcomes in patients with hepatocellular carcinoma (HCC) treated with bridging locoregional therapy (LRT) before orthotopic liver transplantation (OLT). MATERIALS AND METHODS: The United Network for Organ Sharing (UNOS) database was used to identify all patients in the United States with HCC who were listed for OLT between 2002 and 2013. Mean overall survival (OS) after OLT was stratified based on age, sex, ethnicity, transplant year, region, and insurance status. Kaplan-Meier estimation was used for survival analysis with log-rank test and Cox proportional hazards model to assess independent prognostic factors for OS. RESULTS: Of the 17,291 listed patients with HCC, 14,511 underwent OLT. Mean age was 57.4 years (76.8% male). Favorable sociodemographic factors were associated with increased rates of bridging LRT before OLT and longer wait time on the transplant list and were shown to be independent prognostic factors for prolonged OS after OLT using multivariate analysis. Favorable demographic factors included patient age < 60 years, donor age < 45 years, year of diagnosis between 2008 and 2013, UNOS regions 4 and 5, Asian ethnicity, high functional status, postgraduate education, private payer insurance, and employment at the time of OLT. CONCLUSIONS:Patients with favorable sociodemographics had higher rates of LRT before OLT performed for HCC cure. These patients had longer transplant wait times and longer OS after OLT. Copyright Â
Authors: Cortlandt M Sellers; Johannes Uhlig; Johannes M Ludwig; Tamar Taddei; Stacey M Stein; Joseph K Lim; Hyun S Kim Journal: Cancer Med Date: 2019-08-22 Impact factor: 4.452