title: [Diagnostics and treatment of hepatocellular carcinoma: trends in the Netherlands in the period 2003-2011].
abstract: OBJECTIVE
  To evaluate trends in the distribution of care for patients with hepatocellular carcinoma (HCC) in the past decade.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  We collected data on diagnostic testing and initial treatment of patients with HCC in the period 2003-2011 from the Dutch Cancer Registry.
  
  
  RESULTS
  In the period 2003-2011, 2915 patients were diagnosed with HCC. The proportion of patients given palliative treatment increased significantly, whereas the proportion of patients treated by resection remained stable (approximately 10%). Tumour biopsies were performed in virtually all hospitals. Despite a significant decrease seen in the period studied, tumour biopsy was still performed in more than 50% of cases. The number of hospitals where any treatment was performed increased significantly (from 33% to 62% of all hospitals) and the contribution of treatments in academic hospitals decreased significantly (from 83% to 75%). Transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and resection were mainly performed in academic hospitals (99%, 95% and 79% respectively), whereas about half of the initial sorafenib treatments were given in non-academic hospitals. Only in a few academic hospitals were a minimum of five resections performed annually and (only during the last three years of the period studied) were a minimum of five patients started on sorafenib annually. Significant differences existed between regions in the use of RFA or TACE - both p < 0.001, after case-mix correction.
  
  
  CONCLUSIONS
  In the past decade there was no trend towards centralization of diagnostic testing and treatments for patients with HCC.
authors.affiliation: Universitair Medisch Centrum Utrecht, afd. Maag- Darm- en Leverziekten, Utrecht.
authors.forename: Suzanne
authors.initials: S
authors.lastname: van Meer
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
authors.forename: G H Janina
authors.initials: GH
authors.lastname: Schrier
authors.forename: Cees
authors.initials: C
authors.lastname: Verhoef
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Lydia G M
authors.initials: LG
authors.lastname: van der Geest
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010166:Palliative Care; D010671:Phenylurea Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib