Variations in hepatocellular carcinoma treatment patterns and survival of veteran population across geographic regions

Abstract

Presenter: Michelle Ju MD | University of Texas Southwestern Medical Center Background: Hepatocellular carcinoma (HCC) incidence has doubled in the past decade in the Veteran’s Affairs Health System (VAHS) as a result of increasing cirrhosis prevalence. Our study aims to characterize HCC treatment and patient outcome differences across VAHS geographic regions. Methods: Using the VA Corporate Data Warehouse, we built a comprehensive national dataset of HCC veteran patients diagnosed and treated between 2001-2015. After exclusions our final sample consisted of 13,434 patients. Demographic, clinical, staging (AJCC 6th or 7th edition), treatment and survival data were used to compare patients across 5 VAHS regions: West (W), Midwest (MW), Northeast (NE), Southeast (SE), and Southwest (SW). Univariate and multivariate modeling were used to compare differences in patient and hospital characteristics and identify predictors of survival. Kaplan-Meier and Cox Proportional Hazard regressions were used to compare survival outcomes across regions. Results: Patient age, stage group, and race varied across regions. There were no regional differences in liver function based on MELD. Significant differences in overall treatment and curative-intent treatment rates across VA regions exist. The highest and lowest no-treatment rate was 47.1% in SW and 36.37% in W respectively (p<0.01). The highest and lowest rate of first-line curative treatment was in NE (14.63) and MW (6.48%) respectively. Median overall survival for all HCC stages differed significantly among regions (W: 12 months; NE: 11 months; SE, MW, and SW: 9 months; p<0.01). These survival differences persisted when broken down by stage and were more pronounced for Stage I and II (figure 1). After adjusting for demographic and clinicopathologic factors including liver function and stage, patients treated in non-W regions had an increased risk of mortality compared to those treated in W region. Conclusion: Significant differences in treatment patterns and overall survival exist in HCC patients across VAHS geographic regions. Further studies are needed to identify specific patient or system factors associated with these disparities in order to implement improvement measures.