The effect of treatment delay on survival in patients with hepatocellular cancer.

Abstract

e15645 Background: Hepatocellular cancer (HCC) is the fastest increasing cause of cancer related death in the U.S. Only one-third of patients are candidates for curative treatment, and treatment delays occur in 30% of patients. Data on the effect of treatment delays on HCC survival outcomes are limited to small single center studies. The aim of this study was to identify predictors of treatment delays and the impact of treatment delay on survival. Methods: We conducted a retrospective study using a national cohort of patients from the Department of Veterans Affairs who were diagnosed with HCC from October 1, 2004 to September 30, 2011. Demographics, clinical factors, treatment and death were ascertained from the medical records. Treatment delay was defined as greater than 60 days between HCC diagnosis and first treatment. Treatment was categorized as curative (surgery or ablation), liver-directed therapy, or chemotherapy. Cox Proportional Hazard models were used to examine the effect of treatment delay on survival stratified by stage (BCLC 0 and A, B, or C). Results: Among 742 patients with HCC, 223 (30%) had a treatment delay. The majority of patients were Barcelona Stage C (43%), and 131 patients (17.7%) had metastatic disease. On univariate analysis, patients with treatment delay were more likely to have tumor board discussion, single tumors, and PTSD (p < 0.05). Treatment delay was not associated with increased risk of death for patients with BCLC stage 0 and A (HR 0.74 [0.48-1.14]) or BCLC stage B (HR 0.83 [0.61-1.14]). For BCLC stage C, treatment delay was associated with a 50% decrease in risk of death (HR 0.50 [0.37-0.67]), adjusting for demographics, clinical factors, stage, and treatment. Patients with BCLC stage C HCC and treatment delay were more likely to have curative intent therapy (32.9% vs 16.3%) or liver directed therapy (43.4% vs 36.3%, p = 0.0006) than those with no delay. Conclusions: Treatment delays occurred in 30% of patients. Treatment delay was not associated with increased risk of death for earlier stage HCC, but treatment delay was associated with decreased risk of death for patients with BCLC stage C. This finding may be due to delays from coordination of curative and liver directed therapy that may result in improved survival.