title: Hepatocellular carcinoma survival in uninsured and underinsured patients.
abstract: BACKGROUND
  The incidence of hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) is increasing. The purpose of this study is to establish baseline survival in a medically-underserved population and to evaluate the effect of HCV seropositivity on our patient population.
  
  
  METHODS
  We reviewed clinicopathologic parameters from a prospective tumor registry and medical records from the Harris County Hospital District (HCHD). Outcomes were compared using Kaplan-Meier survival analysis and log-rank tests.
  
  
  RESULTS
  A total of 298 HCC patients were identified. The median survival for the entire cohort was 3.4 mo. There was no difference in survival between the HCV seropositive and the HCV seronegative groups (3.6 mo versus 2.6 mo, P = 0.7). Patients with a survival <1 mo had a significant increase in αfetoprotein (AFP), international normalized ratio (INR), model for end-stage liver disease (MELD) score, and total bilirubin and decrease in albumin compared with patients with a survival ≥ 1 mo.
  
  
  CONCLUSIONS
  Survival for HCC patients in the HCHD is extremely poor compared with an anticipated median survival of 7 mo reported in other studies. HCV seropositive patients have no survival advantage over HCV seronegative patients. Poorer liver function at diagnosis appears to be related to shorter survival. Further analysis into variables contributing to decreased survival is needed.
authors.affiliation: University of Texas Medical School at Houston, Texas 77026, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Harvin
authors.forename: George
authors.initials: G
authors.lastname: Van Buren
authors.forename: Kuojen
authors.initials: K
authors.lastname: Tsao
authors.forename: Putao
authors.initials: P
authors.lastname: Cen
authors.forename: Tien C
authors.initials: TC
authors.lastname: Ko
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wray
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000208:ethnology / Q000401:mortality*; D005260:Female; D019698:Hepatitis C, Chronic / Q000191:economics / Q000208:ethnology / Q000401:mortality; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000191:economics / Q000208:ethnology / Q000401:mortality*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data