Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact

被引:17
作者
Govalan, Rajalakshmi [1 ]
Luu, Michael [2 ,3 ]
Lauzon, Marie [2 ,3 ]
Kosari, Kambiz [3 ,4 ,5 ]
Ahn, Joseph C. [6 ]
Rich, Nicole E. [7 ,8 ]
Nissen, Nicholas [3 ,4 ,5 ]
Roberts, Lewis R. [6 ]
Singal, Amit G. [7 ,8 ]
Yang, Ju Dong [3 ,4 ,9 ]
机构
[1] Cedars Sinai Med Ctr, Dept Med, Los Angeles, CA 90048 USA
[2] Cedars Sinai Med Ctr, Biostat & Bioinformat Res Ctr, Los Angeles, CA 90048 USA
[3] Cedars Sinai Med Ctr, Samuel Oschin Comprehens Canc Inst, Los Angeles, CA 90048 USA
[4] Cedars Sinai Med Ctr, Comprehens Transplant Ctr, Los Angeles, CA 90048 USA
[5] Cedars Sinai Med Ctr, Dept Surg, Los Angeles, CA 90048 USA
[6] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN USA
[7] Univ Texas Southwestern Med Ctr Dallas, Div Digest & Liver Dis, Dallas, TX 75390 USA
[8] Univ Texas Southwestern Med Ctr Dallas, Harold C Simmons Comprehens Canc Ctr, Dallas, TX 75390 USA
[9] Cedars Sinai Med Ctr, Karsh Div Gastroenterol & Hepatol, Los Angeles, CA 90048 USA
基金
美国国家卫生研究院;
关键词
SURVIVAL; CANCER; TIME; DISPARITIES; STAGE; MORTALITY; ABLATION; COHORT; HEALTH; LEAD;
D O I
10.1002/hep4.1795
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Prognosis of hepatocellular carcinoma (HCC) could be affected by lack of or delayed therapy. We aimed to characterize the prevalence, correlates, and clinical impact of therapeutic underuse and delay in patients with HCC. Patients with HCC diagnosed between 2010 and 2017 were analyzed from the United States National Cancer Database. Logistic regression analysis identified factors associated with no and delayed (>90 days after diagnosis) HCC treatment. Cox proportional hazards regression with landmark analysis assessed the association between therapeutic delay and overall survival (OS), accounting for immortal time bias. Of 116,299 patients with HCC, 24.2% received no treatment and 18.4% of treated patients had delayed treatment. Older age, Black, Hispanic, lower socioeconomic status, earlier year of diagnosis, treatment at nonacademic centers, Northeast region, increased medical comorbidity, worse liver dysfunction, and higher tumor burden were associated with no treatment. Among treated patients, younger age, Hispanic, Black, treatment at academic centers, West region, earlier tumor stage, and receipt of noncurative treatment were associated with treatment delays. In multivariable Cox regression with a landmark of 150 days, patients with and without treatment delays had similar OS (adjusted hazard ratio [aHR], 1.01; 95% confidence interval [CI], 0.98-1.04) with a median survival of 33.7 vs. 32.1 months, respectively. However, therapeutic delay was associated with worse OS in patients who had tumor, nodes, and metastases (TNM) stage 1 (aHR, 1.06; 95% CI, 1.01-1.11) or received curative treatment (aHR, 1.12; 95% CI, 1.05-1.18). Conclusion: One-fourth of patients with HCC receive no therapy and one-fifth of treated patients experience treatment delays. Both were associated with demographic, socioeconomic, and clinical characteristics of patients as well as facility type and region. The association between therapeutic delay and survival was stage and treatment dependent.
引用
收藏
页码:223 / 236
页数:14
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