Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality.
Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality.
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DOI：
10.1053/j.gastro.2017.02.040
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发表时间：
2017-06
期刊：
影响因子：
29.4
通讯作者：
VOCAL Study Group
中科院分区：
文献类型：
--
作者：
Serper M;Taddei TH;Mehta R;D'Addeo K;Dai F;Aytaman A;Baytarian M;Fox R;Hunt K;Goldberg DS;Valderrama A;Kaplan DE;VOCAL Study Group
关于影响肝细胞癌（HCC）患者接受积极治疗和结局的提供者和卫生系统因素知之甚少。我们调查了与接受积极HCC治疗和总生存率相关的患者、提供者和卫生系统因素。我们对2008年1月1日至2010年12月31日（n = 3988）诊断为HCC的所有患者进行了一项全国性回顾性队列研究，并随访至2014年12月31日，这些患者通过退伍军人管理局（128家中心）接受治疗。结果是接受积极的HCC治疗（肝移植、切除、局部消融、经动脉治疗或索拉非尼）和总生存率。在调整分析中，在学术附属退伍军人管理局医院接受治疗（比值比[OR]，1.97; 95%置信区间[CI]，1.60-2.41）或多专家评估（OR，1.60; 95%CI，1.15-2.21），但未经过多学科肿瘤委员会审查（OR，1.19; 95%CI，0.98-1.46），与接受积极HCC治疗的可能性较高相关。在时变考克斯比例风险模型中，肝移植（风险比[HR]，0.22; 95% CI，0.16-0.31），肝切除术（HR，0.38; 95% CI，0.28-0.52）、消融治疗（HR，0.63; 95% CI，0.52-0.76）和经动脉治疗（HR，0.83; 95% CI，0.74-0.92）与死亡率降低相关。肝病专家的专科护理（HR，0.70; 95% CI，0.63-0.78），医学肿瘤学家（HR，0.82; 95% CI，0.74-0.91）或外科医生（HR，0.79; 95%CI，0.71-0.89）肝癌诊断后30天内，并由多学科肿瘤委员会审查（HR，0.83; 95% CI，0.77-0.90），与死亡率降低相关。在一项回顾性队列研究中，在VA中心接受治疗的近4000例HCC患者中，接受积极HCC治疗的地理、提供者和系统差异与患者生存相关。应该前瞻性地评估和标准化HCC的多学科护理方法，以改善HCC治疗的可及性并优化结局。
Little is known about provider and health system factors that affect receipt of active therapy and outcomes of patients with hepatocellular carcinoma (HCC). We investigated patient, provider, and health system factors associated with receipt of active HCC therapy and overall survival. We performed a national, retrospective cohort study of all patients diagnosed with HCC from January 1, 2008 through December 31, 2010 (n = 3988) and followed through December 31 2014 who received care through the Veterans Administration (128 centers). Outcomes were receipt of active HCC therapy (liver transplantation, resection, local ablation, transarterial therapy, or sorafenib) and overall survival. In adjusted analyses, receiving care at an academically affiliated Veterans Administration hospital (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.60–2.41) or a multi-specialist evaluation (OR, 1.60; 95% CI, 1.15–2.21), but not review by a multidisciplinary tumor board (OR, 1.19; 95% CI, 0.98–1.46), was associated with a higher likelihood of receiving active HCC therapy. In time-varying Cox proportional hazards models, liver transplantation (hazard ratio [HR], 0.22; 95% CI, 0.16–0.31), liver resection (HR, 0.38; 95% CI, 0.28–0.52), ablative therapy (HR, 0.63; 95% CI, 0.52–0.76), and transarterial therapy (HR, 0.83; 95% CI, 0.74–0.92) were associated with reduced mortality. Subspecialist care by hepatologists (HR, 0.70; 95% CI, 0.63–0.78), medical oncologists (HR, 0.82; 95% CI, 0.74–0.91), or surgeons (HR, 0.79; 95% CI, 0.71–0.89) within 30 days of HCC diagnosis, and review by a multidisciplinary tumor board (HR, 0.83; 95% CI, 0.77–0.90), were associated with reduced mortality. In a retrospective cohort study of almost 4000 patients with HCC cared for at VA centers, geographic, provider, and system differences in receipt of active HCC therapy are associated with patient survival. Multidisciplinary methods of care delivery for HCC should be prospectively evaluated and standardized to improve access to HCC therapy and optimize outcomes.
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影响因子：
13.5
作者：
Giannini, Edoardo G.;Farinati, Fabio;Trevisani, Franco
通讯作者：
Trevisani, Franco
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.1097/coc.0000000000000000
发表时间：
2015-12-01
影响因子：
2.6
作者：
Chirikov, Viktor V.;Mullins, C. Daniel;Shaya, Fadia T.
通讯作者：
Shaya, Fadia T.
影响因子：
254.7
作者：
Jemal, Ahmedin;Siegel, Rebecca;Ward, Elizabeth
通讯作者：
Ward, Elizabeth
DOI：
10.1016/j.jamcollsurg.2013.07.007
发表时间：
2013-11
影响因子：
5.2
作者：
Hyder, Omar;Dodson, Rebecca M.;Nathan, Hari;Herman, Joseph M.;Cosgrove, David;Kamel, Ihab;Geschwind, Jean-Francois H.;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.