Abstract
To define current use of surgical therapies for hepatocellular carcinoma (HCC) and evaluate the correlation of various patient and hospital characteristics with the receipt of these interventions. Retrospective cohort. California Cancer Registry data linked to the Office of Statewide Health Planning and Development patient discharge abstracts between 1996 and 2006. Patients with primary HCC. Receipt of liver transplant, hepatic resection, or local ablation. Of 12,148 HCC cases, 2390 (20%) underwent surgical intervention. Three hundred eleven (2.56%) received a liver transplant, 1307 (10.8%) underwent resection, and 772 (6.35%) had local ablation. There were wide variations in treatment by race and hospital type. African American and Hispanic patients were less likely than white patients to undergo transplant (P < .05). African American and Hispanic patients were less likely than white and Asian/Pacific Islander patients to have hepatectomy or ablation (P < .05). In multivariable analysis, the apparent differences in surgical intervention by race/ethnicity were decreased when adjusting for the patients' socioeconomic and insurance statuses. Patients with lower socioeconomic status and no private insurance were less likely to receive any surgery (P < .01). Hospital characteristics also explained some variations. Disproportionate Share Hospitals and public, rural, and nonteaching hospitals were less likely to offer surgical treatment (P < .01). There are significant racial, socioeconomic, and hospital-type disparities in surgical treatment of HCC.
Highlights
ObjectivesTo define current use of surgical therapies for hepatocellular carcinoma (HCC) and evaluate the correlation of various patient and hospital characteristics with the receipt of these interventions
Its mortality rates in the United States have been increasing, and incidence has more than doubled in the last quarter century, with 6.7 per 100 000 new cases recorded in 2006, compared with 2.6 per 100 000 incidence rate in 1975.1 This is largely because of an increase in the prevalence of chronic hepatitis B and C, improvements in screening and diagnosis have contributed to more accurate epidemiologic assessments
This data set was subsequently linked to hospital characteristics from the publicly available California Hospital Annual Financial Data File (HAFD).[14]
Summary
To define current use of surgical therapies for hepatocellular carcinoma (HCC) and evaluate the correlation of various patient and hospital characteristics with the receipt of these interventions
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