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

描述（由申请人提供）：肝细胞癌（HCC）是最常见的实体器官肿瘤，也是世界上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，这种癌症的发病率在过去十年中在美国翻了一番，全球每年诊断出约100万新病例。传统上，早期HCC的治愈性治疗是手术。然而，射频消融术（RFA）最近在HCC的治疗中得到了普及。RFA提供了许多优于手术治疗的潜在优势。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，并允许非手术医生（如介入放射科医生）有机会治疗HCC患者。RFA成功地消融了组织，但其作为HCC的主要治愈性治疗的有效性尚未得到很好的检验。社区如何使用RFA也是未知的。最近的数据表明，RFA正在成为早期HCC的主要治疗选择，但没有质量证据支持这种做法。拟议的研究旨在使用一个大型的、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HCC在社区中的治疗方式，检测RFA使用的趋势，并评估与HCC护理相关的结果。我们计划使用1992年至2005年间诊断为肝癌的患者队列1。）描述RFA使用的阶段特定时间趋势; 2.）描述与RFA使用相关的区域差异以及患者和医生/医院层面因素; 3.）在调整相关因素后，描述接受RFA的患者与接受手术治疗的患者之间30天死亡率的差异; 4.）描述了在调整相关因素后，接受RFA和接受手术治疗的早期HCC患者的总体和病因特异性生存率的差异。将使用逻辑回归来检查RFA使用随时间推移的趋势，并评价RFA使用的潜在预测因素。还将使用逻辑回归来探索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。将使用考克斯多变量回归来探索RFA使用与长期生存率之间的关系，同时调整分期以及患者和提供者因素。这项工作对提高外科护理质量具有重要意义，这些发现将有助于为未来的前瞻性临床试验提供信息，旨在阐明RFA在治疗HCC中的作用

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