Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: A population-based study
Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: A population-based study
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DOI：
10.1016/j.jhep.2005.10.002
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发表时间：
2006-01-01
影响因子：
25.7
通讯作者：
McGlynn, KA
中科院分区：
文献类型：
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作者：
El-Serag, HB;Siegel, AB;McGlynn, KA
背景/目的：对于诊断为肝细胞癌（HCC）的患者，有几种治疗方法可供选择。然而，无论是潜在的治愈性或姑息性疗法用于治疗HCC的程度，也不知道使用这种疗法的决定因素。此外，目前还不清楚如何有效的不同方式治疗hcch.Methods：我们使用了SEER-医疗数据集的链接，以确定1992年和1999年之间诊断为肝癌的患者。我们确定了2963名连续参加Medicare的患者，他们没有参加Medicare HMO。HCC治疗分为潜在治愈性治疗（切除、移植、局部消融）或姑息性治疗（经动脉化疗栓塞（TACE）、化疗）和无治疗。在单变量和多变量分析中，将人口统计学（年龄、性别、种族、地理区域）、临床（合并症、风险因素和肝病严重程度）和肿瘤因素（肿瘤大小、疾病程度）作为治疗的潜在决定因素以及生存率进行了检查。生存曲线也产生和比较不同的治疗models.Results：诊断时的中位年龄为74岁（范围：32-105），大多数患者（91%）年龄大于65岁。约68%为白色，10%为黑人，4%为西班牙裔，8%为亚裔，9%为其他种族。13%的患者接受了潜在的治愈性治疗（移植0.9%、切除8.2%、局部消融4.1%），4%接受了TACE，57%接受了其他姑息性治疗，26%未接受特殊治疗。513例单发病灶患者中仅34%和143例病灶< 3.0 cm患者中仅34%接受了潜在的治愈性治疗。然而，19.2%的具有不利肿瘤特征（病变> 10.0 cm）的患者接受了此类治疗。在接受潜在治愈性治疗的患者（n = 392）中，切除术是最常见的手术（n = 243，62%），其次是局部消融（n = 122，31%），最后是移植（n = 27，7%）。在回归分析中，在调整人口统计学、临床和肿瘤特征后，治愈性治疗的程度和类型的地理差异仍然存在。中位总生存期为104天，肝细胞癌诊断后，移植组生存期最长（852天），未治疗组生存期最短（58天）。在生存分析中，移植导致最长的生存期，其次是切除。无论是消融术，也没有TACE产生延长生存期（3年生存率低于10%）。结论：在这主要是65岁及以上的医疗保险人口，有显着的地理差异，在管理肝细胞癌，似乎是至少一样重要的临床和肿瘤相关的功能，在确定的程度和类型的肝细胞癌治疗。即使在那些具有良好肿瘤特征的患者中，潜在的治愈性治疗也未得到充分利用。由Elsevier B. V.代表欧洲肝脏研究协会出版。
Background/Aims: There are several treatment alternatives available for patients diagnosed with hepatocellular carcinoma (HCC). Yet, neither the extent to which potentially curative or palliative therapy is used to treat HCC, nor the determinants of using such therapies are known. Further, it is unclear how effective different modalities are for treating HCC.Methods: We used the linked SEER-Medicare dataset to identify patients diagnosed with HCC between 1992 and 1999. We identified 2963 patients with continuous Medicare enrollment who were not enrolled in a Medicare-HMO. HCC treatments were categorized as potentially curative therapy (resection, transplant, local ablation), or palliative (trans-arterial chemoembolization (TACE), chemotherapy), and no therapy. Demographic (age, sex, race, geographic region), clinical (comorbidity, risk factors and severity of liver disease) and tumor factors (tumor size, extent of disease) were examined as potential determinants of therapy, as well as survival in univariate and multivariable analyses. Survival curves were also generated and compared among the different treatment modalities.Results: The median age at diagnosis was 74 years (range: 32-105), and most patients (91%) were older than 65 years. Approximately 68% were White, 10% Black, 4% Hispanic, 8% Asian, and 9% were of other race. Thirteen percent of the patients received potentially curative therapy (transplant 0.9%, resection 8.2%, local ablation 4.1%), 4% received TACE,57% received other palliative therapy, and 26% received no specific therapy. Only 34% of 513 patients with single lesions, and 34% of 143 patients with lesions < 3.0 cm received potentially curative therapy. However, 19.2% of patients with unfavorable tumor features (lesion > 10.0 cm) received such therapy. Among patients who received potentially curative therapy (n = 392), resection was the most common procedure (n = 243,62%) followed by local ablation (n = 122, 31%) and finally transplantation (n = 27, 7%). In regression analyses, geographic variations in the extent and type of curative therapy persisted after adjusting for demographic, clinical, and tumor features. Median overall survival was 104 days following HCC diagnosis with the longest survival in the transplant group (852 days) and the shortest survival in the group with no treatment (58 days). In the survival analysis, transplantation led to the longest survival, followed by resection. Neither ablation nor TACE yielded prolonged survival (3 year survival was less than 10%).Conclusions: In this predominantly 65 years and older Medicare population, there are marked geographic variations in the management of HCC that seem to be at least as important as clinical and tumor-related features in determining the extent and type of HCC therapy. There is underutilization of potentially curative therapy, even among those with favorable tumor features. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.