Abstract
Background: Despite wide availability of treatment options for hepatocellular carcinoma (HCC), a significant proportion of HCC patients do not receive any specific treatment. This study aimed to analyze the proportion, characteristics and prognosis of untreated HCC patients in a large representative nationwide study. Methods: A cohort study was conducted using the National Health Insurance Service (NHIS) database in Korea. A total of 63,668 newly-diagnosed HCC patients between January 2008 and December 2013 were analyzed. Patients were categorized into treatment group and no treatment group using claim codes after HCC diagnosis. Findings: The proportion of untreated HCC patients was 27.6%, decreasing from 33.4% in 2008 to 24.8% in 2013. Compared to treated patients, untreated patients were more likely to be older (>70 years of age, 29.3% vs. 16.0%, P < 0.001), female (20.8% vs. 19.6%, P < 0.01), to have a distant SEER stage (19.4% vs. 8.7%, P < 0.001), severe liver disease (14.6% vs. 10.0%, P < 0.001), and lower income (Medicaid beneficiary, 17.0% vs. 12.7%, P < 0.001). The fully-adjusted hazard ratio for all-cause mortality comparing untreated to treated patients was 3.11 (95% CI, 3.04-3.18). The risk of mortality was higher for untreated patients in all pre-defined subgroups, including those with distant SEER stage and those with severe liver disease. Interpretation: About one fourth of newly diagnosed HCC patients did not receive any specific treatment. Untreated patients showed higher risk of mortality compared to treated patients in all subgroups. Further studies are needed to identify obstacles for HCC treatment and to improve treatment rates. Funding Statement: National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1520240). Declaration of Interests: All authors have no conflict of interest to declare. Ethics Approval Statement: The Institutional Review Board of the Korean National Cancer Center approved this study and waived the requirement for informed consent because of the retrospective nature of our study using de-identified data.
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