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

描述(申请人提供)：肝细胞癌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。这种癌症很可能是1970年S和1980年S丙型肝炎流行的结果，在过去十年中，这种癌症在美国的发病率翻了一番，全球每年约有100万新确诊病例。传统上，早期肝细胞癌的根治方法是手术治疗。然而，射频消融术(RFA)最近在肝细胞癌的治疗中越来越受欢迎。与外科治疗相比，射频消融术具有许多潜在的优势。它可以通过微创方法应用，可以作为门诊程序进行，允许在没有资源进行外科切除或移植的护理环境中治疗肝癌，并允许非外科从业者(如介入放射科医生)有机会治疗肝癌患者。RFA成功地消融了组织，但它作为一种主要的、根治的肝癌治疗方法的有效性还没有得到很好的测试。整个社区如何利用RFA也是未知的。最近的数据表明，RFA正在成为早期肝癌的主要治疗选择，而没有高质量的证据支持这一做法。这项拟议的研究旨在使用大型、基于人群的癌症登记(SEER)以及相关的医疗保险索赔数据(SEER-Medicare)，以更好地定义整个社区如何治疗肝癌，检测RFA的使用趋势，并评估与肝癌护理相关的结果。使用1992至2005年间被诊断为肝癌的患者队列，我们计划1。描述RFA使用的特定阶段的时间趋势；2.描述与RFA使用相关的区域差异和患者和医生/医院层面的因素；3.描述在调整了相关因素后，接受RFA治疗的患者和接受手术治疗的患者之间30天死亡率的差异；描述接受RFA治疗的早期肝细胞癌患者和在调整相关因素后接受手术治疗的患者在总体生存率和病因特异性生存率方面的差异。Logistic回归将用于检查RFA使用随时间推移的趋势，并评估RFA使用的潜在预测因素。Logistic回归也将被用来探索RFA的使用和早期死亡率之间的关系，同时调整分期以及患者和提供者的因素。在调整分期以及患者和提供者因素的同时，将使用COX多变量回归来探索RFA的使用与长期生存之间的关系。这项工作对提高外科治疗的质量有意义，这些发现将有助于为未来的前瞻性临床试验提供信息，这些试验旨在阐明RFA在肝癌治疗中的作用。

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