title: Surgical therapy for early hepatocellular carcinoma in the modern era: a 10-year SEER-medicare analysis.
abstract: OBJECTIVE
  We sought to quantify the use of and analyze factors predictive of receipt of surgical therapy for early hepatocellular carcinoma (HCC).
  
  
  BACKGROUND
  The incidence of HCC is increasing, and the options for surgical therapy for early HCC have expanded, but the use of surgical therapy for early HCC has not been examined in a modern cohort.
  
  
  METHODS
  A retrospective cohort study was performed using data from the 1998-2007 Surveillance, Epidemiology, and End Results-Medicare linked database. Data were analyzed for patients 66 years of age and older with early HCC (tumors ≤5 cm without metastatic disease, nodal metastasis, extrahepatic extension, or major vascular invasion). Both Surveillance, Epidemiology, and End Results and Medicare data were used to ascertain receipt of therapy as well as comorbidity burden and other patient and hospital variables. Multivariable logistic regression models were used to analyze factors associated with receipt of therapy.
  
  
  RESULTS
  Our selection criteria identified 1745 patients for this study. Most patients had tumors between 2 and 5 cm in size (n = 1440, 83%). Solitary tumors (n = 1121, 64%) were more common than multiple tumors (n = 624, 36%). A total of 820 patients (47%) with early HCC received no surgical therapy. Among 741 patients with solitary, unilobar tumors and microscopic confirmation of HCC, 246 (33%) received no surgical therapy. Of 535 patients with no liver-related comorbidities, 273 (51%) did not receive surgical therapy. In multivariable analysis, patient age, income, tumor factors, liver-related comorbidities, and hospital factors were associated with receipt of surgical therapy.
  
  
  CONCLUSIONS
  Although some patients with early HCC may not be candidates for surgical therapy, these data suggest that there is a significant missed opportunity to improve survival of patients with early HCC through the use of surgical therapy.
authors.affiliation: From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: Skye C
authors.initials: SC
authors.lastname: Mayo
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors; D014481:United States