Surgical resection of early stage hepatocellular carcinoma improves patient survival at safety net hospitals.
HCC
safety-net hospital
surgical resection
survival
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
19
11
2020
revised:
30
12
2020
accepted:
04
01
2021
pubmed:
27
1
2021
medline:
11
3
2021
entrez:
26
1
2021
Statut:
ppublish
Résumé
Surgical resection is indicated for hepatocellular carcinoma (HCC) patients with Child A cirrhosis. We hypothesize that surgical intervention and survival are limited by advanced HCC presentation at safety net hospitals (SNHs) versus academic medical centers (AMCs). Patients with HCC and Child A cirrhosis in the US Safety Net Collaborative (2012-2014) were evaluated. Demographics, clinicopathologic features, operative characteristics, and outcomes were compared between SNHs and AMCs. Liver transplantation was excluded. Kaplan-Meier and Cox proportional-hazards models were used to identify the effect of surgery on overall (OS). A total of 689 Child A patients with HCC were identified. SNH patients frequently presented with T3/T4 stage (35% vs. 24%) and metastases (17% vs. 8%; p < .05). SNH patients were as likely to undergo surgery as AMC patients (17% vs. 18%); however, SNH patients were younger (56 vs. 64 years), underwent minor hepatectomy (65% vs. 38%), and frequently harbored well-differentiated tumors (23% vs. 2%; p < .05). On multivariate analysis, surgical resection and stage, but not hospital type, were associated with improved OS. Although SNH patients present with advanced HCC, survival outcomes for early stage HCC are similar at SNHs and AMCs. Identifying barriers to early diagnosis at SNH may increase surgical candidacy and improve outcomes.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Surgical resection is indicated for hepatocellular carcinoma (HCC) patients with Child A cirrhosis. We hypothesize that surgical intervention and survival are limited by advanced HCC presentation at safety net hospitals (SNHs) versus academic medical centers (AMCs).
METHODS
METHODS
Patients with HCC and Child A cirrhosis in the US Safety Net Collaborative (2012-2014) were evaluated. Demographics, clinicopathologic features, operative characteristics, and outcomes were compared between SNHs and AMCs. Liver transplantation was excluded. Kaplan-Meier and Cox proportional-hazards models were used to identify the effect of surgery on overall (OS).
RESULTS
RESULTS
A total of 689 Child A patients with HCC were identified. SNH patients frequently presented with T3/T4 stage (35% vs. 24%) and metastases (17% vs. 8%; p < .05). SNH patients were as likely to undergo surgery as AMC patients (17% vs. 18%); however, SNH patients were younger (56 vs. 64 years), underwent minor hepatectomy (65% vs. 38%), and frequently harbored well-differentiated tumors (23% vs. 2%; p < .05). On multivariate analysis, surgical resection and stage, but not hospital type, were associated with improved OS.
CONCLUSIONS
CONCLUSIONS
Although SNH patients present with advanced HCC, survival outcomes for early stage HCC are similar at SNHs and AMCs. Identifying barriers to early diagnosis at SNH may increase surgical candidacy and improve outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
963-969Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
Rich NE, Yopp AC, Singal AG, Murphy CC. Hepatocellular carcinoma incidence is decreasing among younger adults in the United States. Clin Gastroenterol Hepatol. 2020;18(1):242-248.
Nathan H, Schulick RD, Choti MA, Pawlik TM. Predictors of survival after resection of early hepatocellular carcinoma. Ann Surg. 2009;249(5):799-805.
Roayaie S, Obeidat K, Sposito C, et al. Resection of hepatocellular cancer</=2 cm: results from two Western centers. Hepatology. 2013;57(4):1426-1435.
Sloane D, Chen H, Howell C. Racial disparity in primary hepatocellular carcinoma: tumor stage at presentation, surgical treatment and survival. J Natl Med Assoc. 2006;98:1934-1939.
Mokdad AA, Murphy CC, Pruitt SL, et al. Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma. Cancer. 2018;124(4):743-751.
Kamath PS, Kim WR, Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007;45:797-805.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-649.
Belghiti J, Kianmanesh R. Surgical treatment of hepatocellular carcinoma. HPB. 2005;7(1):42-49.
Carrion AF, Ghanta R, Carrasquillo O, Martin P. Chronic liver disease in the Hispanic population of the United States. Clin Gastroenterol Hepatol. 2011;9(10):834-841.
Hoehn RS, Hanseman DJ, Dhar VK, Go DE, Edwards MJ, Shah SA. Opportunities to improve care of hepatocellular carcinoma in vulnerable patient populations. J Am Coll Surg. 2017;224(4):697-704.
Duininck G, Lopez-Aguiar AG, Lee RM, et al. Optimizing cancer care for hepatocellular carcinoma at a safety-net hospital: the value of a multidisciplinary disease management team. J Surg Oncol. 2019;120(8):1365-1370.
Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378-90.
Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020;382(20):1894-1905.
Abou-Alfa GK, Meyer T, Cheng AL, et al. Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med. 2018;379(1):54-63.
Popescu I, Fingar KR, Cutler E, Guo J, Jiang HJ. Comparison of 3 Safety-Net Hospital Definitions and Association With Hospital Characteristics. JAMA Netw Open. 2019;2:e198577.
Vincent Rajkumar S. The high cost of prescription drugs: causes and solutions. Blood Cancer J. 2020;10(6):71.
Wakeam E, Hevelone ND, Maine R, et al. Failure to rescue in safety-net hospitals: availability of hospital resources and differences in performance. JAMA Surg. 2014;149(3):229-235.
Lee TC, Dhar VK, Hoehn RS, et al. Liver transplantation at safety net hospitals: potentially vulnerable patients with noninferior outcomes. Surgery. 2019;166(6):1135-1141.
Hoehn RS, Wima K, Vestal MA, et al. Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg. 2016;151(2):120-128.
Warner SG, Jutric Z, Nisimova L, Fong Y. Early recovery pathway for hepatectomy: data-driven liver resection care and recovery. Hepatobiliary Surg Nutr. 2017;6(5):297-311.
Zhao Y, Qin H, Wu Y, Xiang B. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine. 2017;96(31):e7628.