Utilization and outcomes of palliative therapy for hepatocellular carcinoma: a population-based study in the United States.
Utilization and outcomes of palliative therapy for hepatocellular carcinoma: a population-based study in the United States.
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DOI：
10.1097/mcg.0b013e318224d669
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发表时间：
2012-01
影响因子：
2.9
通讯作者：
El-Serag HB
中科院分区：
文献类型：
--
作者：
Davila JA;Duan Z;McGlynn KA;El-Serag HB
评价肝癌姑息治疗的利用率、决定因素及其对生存率的影响。肝细胞癌（HCC）的姑息治疗，包括经动脉化疗栓塞（TACE）和全身化疗，可用于未接受潜在治愈性治疗的患者。这些疗法在临床实践中的使用和结局尚不清楚。我们进行了一项基于人群的队列研究，使用了与2000-2005年期间诊断为HCC且未接受肝移植、切除或消融的>65岁患者的医疗保险索赔相关的监测、流行病学和最终结果登记数据。根据肿瘤分期、肝脏疾病状态和非HCC合并症计算接受TACE或全身化疗的患者比例。在逻辑回归模型中检查接受姑息治疗的决定因素，并计算倾向评分。采用考克斯比例风险模型评价死亡风险。我们确定了3，163例HCC患者（中位年龄：75岁，67%为男性），他们没有接受潜在的治愈性治疗。约12.5%接受TACE，11.0%接受化疗。在早期或中期HCC患者中，无肝功能失代偿，很少或没有合并症，仅22.8%接受TACE，13.8%接受化疗。接受TACE（14.0个月）的患者的中位生存期显著高于化疗（5.0个月）或未接受治疗（2.0个月）的患者。观察到TACE（54%）和化疗（33%）的总体死亡率显著降低。肝癌姑息治疗的利用率低，不能用临床特征来解释。然而，由于数据来源的原因，可能会发生错误分类。接受TACE或全身化疗与死亡率降低相关。
To evaluate the utilization and determinants of receiving palliative treatment for HCC, and its effect on survival. Palliative treatment for hepatocellular carcinoma (HCC), including transarterial chemoembolization (TACE) and systemic chemotherapy, is available for patients who do not receive potentially curative therapy. The utilization and outcomes of these therapies in clinical practice are unknown. We conducted a population-based cohort study using Surveillance, Epidemiology, and End-Results registry data linked to Medicare claims of HCC patients >65 years diagnosed during 2000–2005 who did not receive liver transplant, resection, or ablation. The proportions of patients who received TACE or systemic chemotherapy were calculated by tumor stage, liver disease status, and non-HCC co-morbidity. Determinants of receiving palliative therapy were examined in logistic regression models and propensity scores were calculated. Cox proportional hazards models were used to evaluate mortality risk. We identified 3,163 HCC patients (median age: 75 yrs, 67% men) who did not receive potentially curative treatment. Approximately 12.5% received TACE and 11.0% chemotherapy. In patients with early or intermediate stage HCC, no liver decompensation, and little or no co-morbidity, only 22.8% received TACE and 13.8% chemotherapy. Median survival was significantly higher among patients who received TACE (14.0 months) compared to chemotherapy (5.0 months) or no therapy (2.0 months). A significant reduction in overall mortality was observed for TACE (54%) and chemotherapy (33%). Utilization of palliative treatment for HCC is low, which could not be explained by clinical features. However, misclassification could have occurred due to the data source. Receipt of TACE or systemic chemotherapy was associated with a reduction in mortality.