Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact.
Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact.
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DOI：
10.1002/hep4.1795
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发表时间：
2022-01
影响因子：
5.1
通讯作者：
Yang JD
中科院分区：
文献类型：
--
作者：
Govalan R;Luu M;Lauzon M;Kosari K;Ahn JC;Rich NE;Nissen N;Roberts LR;Singal AG;Yang JD
肝细胞癌（HCC）的预后可能会受到缺乏或延迟治疗的影响。我们的目的是描述HCC患者治疗使用不足和延迟的患病率、相关因素和临床影响。分析了2010年至2017年期间诊断为HCC的患者，这些患者来自美国国家癌症数据库。Logistic回归分析确定了与无和延迟（诊断后>90天）HCC治疗相关的因素。考克斯比例风险回归和地标分析评估治疗延迟和总生存期（OS）之间的关系，解释不朽的时间偏倚。在116，299例HCC患者中，24.2%的患者未接受治疗，18.4%的治疗患者延迟治疗。年龄较大、黑人、西班牙裔、较低的社会经济地位、较早的诊断年份、在非学术中心、东北地区接受治疗、医疗合并症增加、肝功能障碍加重和肿瘤负荷增加与未接受治疗相关。在接受治疗的患者中，年龄较小、西班牙裔、黑人、在学术中心接受治疗、西部地区、肿瘤分期较早和接受非治愈性治疗与治疗延迟相关。在多变量考克斯回归中，以150天为标志，有和无治疗延迟的患者具有相似的OS（校正的风险比[aHR]，1.01; 95%置信区间[CI]，0.98 - 1.04），中位生存期分别为33.7个月和32.1个月。然而，在肿瘤、淋巴结和转移（TNM）1期（aHR，1.06; 95% CI，1.01 - 1.11）或接受根治性治疗（aHR，1.12; 95% CI，1.05 - 1.18）的患者中，治疗延迟与OS恶化相关。结论：四分之一的HCC患者未接受治疗，五分之一的治疗患者出现治疗延迟。两者均与患者的人口统计学、社会经济学和临床特征以及设施类型和地区相关。治疗延迟和生存率之间的关系是阶段和治疗依赖性的。四分之一的HCC患者没有接受治疗，五分之一的治疗患者出现治疗延迟。两者均与人口统计学、社会经济学、患者临床特征、设施类型和地区相关。治疗延迟与生存率之间的相关性是阶段和治疗依赖性的。治疗延迟与早期HCC或接受根治性治疗的患者的OS较差相关。
Prognosis of hepatocellular carcinoma (HCC) could be affected by lack of or delayed therapy. We aimed to characterize the prevalence, correlates, and clinical impact of therapeutic underuse and delay in patients with HCC. Patients with HCC diagnosed between 2010 and 2017 were analyzed from the United States National Cancer Database. Logistic regression analysis identified factors associated with no and delayed (>90 days after diagnosis) HCC treatment. Cox proportional hazards regression with landmark analysis assessed the association between therapeutic delay and overall survival (OS), accounting for immortal time bias. Of 116,299 patients with HCC, 24.2% received no treatment and 18.4% of treated patients had delayed treatment. Older age, Black, Hispanic, lower socioeconomic status, earlier year of diagnosis, treatment at nonacademic centers, Northeast region, increased medical comorbidity, worse liver dysfunction, and higher tumor burden were associated with no treatment. Among treated patients, younger age, Hispanic, Black, treatment at academic centers, West region, earlier tumor stage, and receipt of noncurative treatment were associated with treatment delays. In multivariable Cox regression with a landmark of 150 days, patients with and without treatment delays had similar OS (adjusted hazard ratio [aHR], 1.01; 95% confidence interval [CI], 0.98‐1.04) with a median survival of 33.7 vs. 32.1 months, respectively. However, therapeutic delay was associated with worse OS in patients who had tumor, nodes, and metastases (TNM) stage 1 (aHR, 1.06; 95% CI, 1.01‐1.11) or received curative treatment (aHR, 1.12; 95% CI, 1.05‐1.18). Conclusion: One‐fourth of patients with HCC receive no therapy and one‐fifth of treated patients experience treatment delays. Both were associated with demographic, socioeconomic, and clinical characteristics of patients as well as facility type and region. The association between therapeutic delay and survival was stage and treatment dependent. One‐fourth of HCC patients receive no therapy and one‐fifth of treated patients experience treatment delays. Both were associated with demographic, socioeconomic, clinical characteristics of patients, facility type, and regions. The association between therapeutic delay and survival was stage‐ and treatment‐dependent. Therapeutic delay was associated with worse OS in patients who had early‐stage HCC or received curative treatment.
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DOI：
10.1016/j.jhepr.2021.100260
发表时间：
2021-06
期刊：
JHEP reports : innovation in hepatology
影响因子：
--
作者：
Muñoz-Martínez S;Sapena V;Forner A;Nault JC;Sapisochin G;Rimassa L;Sangro B;Bruix J;Sanduzzi-Zamparelli M;Hołówko W;El Kassas M;Mocan T;Bouattour M;Merle P;Hoogwater FJH;Alqahtani SA;Reeves HL;Pinato DJ;Giorgakis E;Meyer T;Villadsen GE;Wege H;Salati M;Mínguez B;Di Costanzo GG;Roderburg C;Tacke F;Varela M;Galle PR;Alvares-da-Silva MR;Trojan J;Bridgewater J;Cabibbo G;Toso C;Lachenmayer A;Casadei-Gardini A;Toyoda H;Lüdde T;Villani R;Matilla Peña AM;Guedes Leal CR;Ronzoni M;Delgado M;Perelló C;Pascual S;Lledó JL;Argemi J;Basu B;da Fonseca L;Acevedo J;Siebenhüner AR;Braconi C;Meyers BM;Granito A;Sala M;Rodríguez-Lope C;Blaise L;Romero-Gómez M;Piñero F;Gomez D;Mello V;Pinheiro Alves RC;França A;Branco F;Brandi G;Pereira G;Coll S;Guarino M;Benítez C;Anders MM;Bandi JC;Vergara M;Calvo M;Peck-Radosavljevic M;García-Juárez I;Cardinale V;Lozano M;Gambato M;Okolicsanyi S;Morales-Arraez D;Elvevi A;Muñoz AE;Lué A;Iavarone M;Reig M
通讯作者：
Reig M
影响因子：
24.5
作者：
Nathani P;Gopal P;Rich N;Yopp A;Yokoo T;John B;Marrero J;Parikh N;Singal AG
通讯作者：
Singal AG
影响因子：
25.7
作者：
Lim, Chetana;Bhangui, Prashant;Azoulay, Daniel
通讯作者：
Azoulay, Daniel
影响因子：
1.9
作者：
Huo, Teh-Ia;Huang, Yi-Hsiang;Lee, Shou-Dong
通讯作者：
Lee, Shou-Dong
影响因子：
9.8
作者：
Mokdad, Ali A.;Zhu, Hong;Yopp, Adam C.
通讯作者：
Yopp, Adam C.