A Population-Based Analysis of Care and Outcomes for Hepatocellular Carcinoma

基于人群的肝细胞癌护理和结果分析

• 批准号: 7541665
• 负责人: Nader Nabile Massarweh
• 金额: $ 5.47万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7541665
• 关键词: Ablation; Adoption; Caring; Characteristics; Clinical; Clinical Trials; Cohort Studies; Communities; Data; Diagnosis; Disease; Disease regression; Early treatment; Environment; Epidemic; Excision; Future; Geographic Locations; Goals; Hepatic; Hepatitis C; Hospitals; Incidence; Intervention; Invasive; Link; Liver neoplasms; Logistic Regressions; Malignant Neoplasms; Medicare; Morbidity - disease rate; Numbers; Operative Surgical Procedures; Organ; Outcome; Outpatients; Patients; Personal Satisfaction; Physicians; Platelet Factor 4; Population; Primary carcinoma of the liver cells; Procedures; Provider; Radiation; Radiofrequency Interstitial Ablation; Rate; Relative (related person); Research; Resources; Role; Safety; Solid; Staging; Standards of Weights and Measures; Surgeon; Surgical Management; Survival Rate; Techniques; Testing; Time; Tissues; Training; Transplantation; Uncertainty; United States; Variant; Work; base; cancer care; chemotherapy; cohort; day; improved; interest; liver transplantation; mortality; neoplasm registry; new technology; prospective; radiologist; socioeconomics; trend; tumor

DESCRIPTION (provided by applicant): Hepatocellular carcinoma (HCC) is the most common solid organ tumor and one of the most frequently encountered malignancies in the world. Likely a result of the hepatitis C epidemic of the 1970's and 1980's, the incidence of this cancer has doubled in the United States during the past decade and worldwide approximately 1 million new cases are diagnosed per year. Traditionally, curative therapy for early-stage HCC has been surgical. However, radiofrequency ablation (RFA) has recently gained popularity in the treatment of HCC. RFA offers a number of potential advantages over surgical therapy. It can be applied through a minimally invasive approach, may be performed as an outpatient procedure, allows treatment of HCC in care environments that do not have the resources to perform surgical resection or transplantation, and allows non-surgical practitioners (such as interventional radiologists) the opportunity to treat patients with HCC. RFA successfully ablates tissue, but its efficacy as a primary, curative treatment for HCC has not been well tested. How the community at large utilizes RFA is also unknown. Recent data suggests RFA is becoming a primary treatment option for early stage HCC without quality evidence to support this practice. The proposed research intends to use a large, population-based cancer registry (SEER) as well as linked Medicare claims data (SEER-Medicare) to better define how HCC is treated in the community at large, to detect trends in the use of RFA, and evaluate outcomes associated with HCC care. Using a cohort of patients diagnosed with HCC between 1992 and 2005, we plan to 1.) describe stage-specific temporal trends in RFA use; 2.) characterize regional variation and patient- and physician/hospital-level factors associated with the use of RFA; 3.) describe differences in 30-day mortality between patients who received RFA and those who underwent surgical therapy after adjusting for relevant factors; 4.) describe differences in overall and cause-specific survival among patients with early-stage HCC who received RFA and those who underwent surgical therapy after adjusting for relevant factors. Logistic regression will be used to examine trends in RFA use over time and to evaluate potential predictors of RFA use. Logistic regression will also be used to explore the relationship between RFA use and early mortality while adjusting for stage as well as patient and provider factors. Cox multivariate regression will be used to explore the relationship between RFA use and long-term survival while adjusting for stage as well as patient and provider factors. This work has implications for improving the quality of surgical care and these findings will help to inform future, prospective clinical trials aimed at clarifying the role for RFA in the treatment of HCC

描述（申请人提供）：肝细胞癌（HCC）是世界上最常见的实体器官肿瘤，也是最常见的恶性肿瘤之一。可能是20世纪70年代和80年代丙型肝炎流行的结果，在过去十年中，这种癌症的发病率在美国翻了一番，全世界每年约有100万新病例被诊断出来。传统上，早期HCC的治疗方法是手术。然而，射频消融（RFA）最近在HCC的治疗中得到了普及。相对于手术治疗，RFA提供了许多潜在的优势。它可以通过微创方法应用，可以作为门诊手术进行，允许在没有资源进行手术切除或移植的护理环境中治疗HCC，并允许非手术从业人员（如介入放射科医生）治疗HCC患者。RFA可以成功地消融组织，但其作为原发性肝癌治疗的疗效尚未得到很好的验证。整个社区如何利用RFA也是未知的。最近的数据显示，RFA正在成为早期HCC的主要治疗选择，但没有高质量的证据支持这种做法。拟议的研究打算使用一个大型的、基于人群的癌症登记处（SEER）以及相关的医疗保险索赔数据（SEER-Medicare）来更好地定义整个社区中HCC的治疗方式，检测RFA使用的趋势，并评估与HCC治疗相关的结果。使用1992年至2005年间诊断为HCC的患者队列，我们计划1.)描述RFA使用的特定阶段的时间趋势；2)描述区域差异以及患者和医生/医院层面与射频消融使用相关的因素；3)在调整相关因素后，描述RFA患者与手术治疗患者30天死亡率的差异；4)在调整相关因素后，描述早期HCC患者接受RFA和接受手术治疗的总生存率和病因特异性生存率的差异。逻辑回归将用于检查随时间推移RFA使用的趋势，并评估RFA使用的潜在预测因素。逻辑回归也将用于探讨RFA使用与早期死亡率之间的关系，同时调整分期以及患者和提供者因素。Cox多元回归将用于探讨RFA使用与长期生存之间的关系，同时调整分期以及患者和提供者因素。这项工作对提高手术护理质量具有重要意义，这些发现将有助于为未来旨在阐明RFA在HCC治疗中的作用的前瞻性临床试验提供信息