Niek A Peters1, Ammar A Javed2, Jin He2, Christopher L Wolfgang2, Matthew J Weiss3. 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: mweiss5@jhmi.edu.
Abstract
BACKGROUND: Underutilization of potential curative surgical treatment remains a problem in the management of hepatocellular carcinoma (HCC). Demographic and socioeconomic disparities continue to be important factors impacting utilization patterns, and exact mechanisms underlying these disparities remain largely unclarified. Focusing on these mechanisms provides us with a potential approach to improve survival of HCC patients. METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results Database to assess patients with early stage HCC diagnosed between January 2004 and December 2012. Demographic and socioeconomic factors were analyzed to assess associations with utilization of treatment, stage of presentation, and disease-specific survival by means of multinominal and Cox regression. RESULTS: A total of 13,694 patients were included in the analysis of which only 6239 (45.6%) underwent surgical treatment for early stage HCC. Surgical treatment options consisted of 1445 liver resections (10.6%), 2121 liver transplantations (15.5%), and 2673 liver ablations (19.5%). The rate of surgical treatment fell from 56.1% in 2004 to 37.8% in 2012. Compared with no surgical therapy, African Americans were less likely to undergo liver transplantation (relative risk ratio [RRR] = 0.54; 95% confidence interval [CI], 0.36-0.79) than Caucasian patients and more likely to undergo surgical resection (RRR = 1.67; 95% CI, 1.13-2.48). Patients from the Pacific West were less likely to be transplanted versus patients from the Southeast (RRR = 0.68; 95% CI, 0.50-0.93). Also, patients who were married (RRR = 2.44; 95% CI, 1.96-3.04) or had health insurance (RRR = 4.74; 95% CI, 1.66-13.6) were more likely to receive liver transplantation. Young age (hazard ratio = 1.02; 95% CI, 1.00-1.03; P = 0.025) and positive marital status (hazard ratio = 0.71; 95% CI, 0.55-0.92; P = 0.010) both were independently associated with increased disease-specific survival. CONCLUSIONS: An increasing proportion of patients with early stage HCC did not undergo surgical therapy between 2004 and 2012. Demographic and socioeconomic factors were associated with different treatment modality utilization after controlling for available confounders. Of these factors, age and marital status were independently associated with increased disease-specific survival.
BACKGROUND: Underutilization of potential curative surgical treatment remains a problem in the management of hepatocellular carcinoma (HCC). Demographic and socioeconomic disparities continue to be important factors impacting utilization patterns, and exact mechanisms underlying these disparities remain largely unclarified. Focusing on these mechanisms provides us with a potential approach to improve survival of HCC patients. METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results Database to assess patients with early stage HCC diagnosed between January 2004 and December 2012. Demographic and socioeconomic factors were analyzed to assess associations with utilization of treatment, stage of presentation, and disease-specific survival by means of multinominal and Cox regression. RESULTS: A total of 13,694 patients were included in the analysis of which only 6239 (45.6%) underwent surgical treatment for early stage HCC. Surgical treatment options consisted of 1445 liver resections (10.6%), 2121 liver transplantations (15.5%), and 2673 liver ablations (19.5%). The rate of surgical treatment fell from 56.1% in 2004 to 37.8% in 2012. Compared with no surgical therapy, African Americans were less likely to undergo liver transplantation (relative risk ratio [RRR] = 0.54; 95% confidence interval [CI], 0.36-0.79) than Caucasian patients and more likely to undergo surgical resection (RRR = 1.67; 95% CI, 1.13-2.48). Patients from the Pacific West were less likely to be transplanted versus patients from the Southeast (RRR = 0.68; 95% CI, 0.50-0.93). Also, patients who were married (RRR = 2.44; 95% CI, 1.96-3.04) or had health insurance (RRR = 4.74; 95% CI, 1.66-13.6) were more likely to receive liver transplantation. Young age (hazard ratio = 1.02; 95% CI, 1.00-1.03; P = 0.025) and positive marital status (hazard ratio = 0.71; 95% CI, 0.55-0.92; P = 0.010) both were independently associated with increased disease-specific survival. CONCLUSIONS: An increasing proportion of patients with early stage HCC did not undergo surgical therapy between 2004 and 2012. Demographic and socioeconomic factors were associated with different treatment modality utilization after controlling for available confounders. Of these factors, age and marital status were independently associated with increased disease-specific survival.
Authors: Nicole E Rich; Caitlin Hester; Mobolaji Odewole; Caitlin C Murphy; Neehar D Parikh; Jorge A Marrero; Adam C Yopp; Amit G Singal Journal: Clin Gastroenterol Hepatol Date: 2018-05-31 Impact factor: 11.382
Authors: Krystal L Karunungan; Yas Sanaiha; Roland A Hernandez; Holly Wilhalme; Sarah Rudasill; Joseph Hadaya; Joseph DiNorcia; Peyman Benharash Journal: Liver Transpl Date: 2020-12-31 Impact factor: 5.799
Authors: Grace C Lee; Cristina R Ferrone; Parsia A Vagefi; Raul N Uppot; Kenneth K Tanabe; Keith D Lillemoe; Lawrence S Blaszkowsky; Motaz Qadan Journal: Am J Surg Date: 2019-01-03 Impact factor: 2.565
Authors: Jin Hean Koh; Darren Jun Hao Tan; Yuki Ong; Wen Hui Lim; Cheng Han Ng; Phoebe Wen Lin Tay; Jie Ning Yong; Mark D Muthiah; Eunice X Tan; Ning Qi Pang; Beom Kyung Kim; Nicholas Syn; Alfred Kow; Brian K P Goh; Daniel Q Huang Journal: Hepatobiliary Surg Nutr Date: 2022-02 Impact factor: 8.265
Authors: Shoshana Adler Jaffe; Orrin Myers; Angela L W Meisner; Charles L Wiggins; Deirdre A Hill; Jean A McDougall Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-12-03 Impact factor: 4.254