title: Survival in relation to hospital type after resection or sorafenib treatment for hepatocellular carcinoma in The Netherlands.
abstract: OBJECTIVE
  Despite an increase in recent years, hepatocellular carcinoma remains uncommon in the Netherlands. The aim of the current study is to explore potential effects of hospital type and volume on outcomes after resection or sorafenib in patients with hepatocellular carcinoma.
  
  
  METHODS
  Initial treatment and survival of patients with hepatocellular carcinoma diagnosed in the period 2005-2011 were based on data of the Netherlands Cancer Registration. Potential risk factors (including hospital type and volume) for 30-days postoperative and long-term mortality in patients who underwent resection and in patients treated with sorafenib were evaluated by uni- and multivariate analyses.
  
  
  RESULTS
  In the period 2005-2011, 2402 patients were diagnosed with hepatocellular carcinoma: 12% received resection and 9% sorafenib. Postoperative mortality was higher in non-university hospitals (13% versus 4%; P=0.01). Resection in non-university hospitals was associated with higher postoperative mortality (odds ratio 3.38, 95% confidence interval 1.37-10.68) and long-term mortality (hazard ratio 1.21, 95% confidence interval 1.04-1.40). Sorafenib treatment in non-university hospitals was also associated with higher long-term mortality (hazard ratio 1.39, 95% confidence interval 1.06-1.82). Hospital volume was not independent predictor for outcome.
  
  
  CONCLUSIONS
  In low incidence countries, outcome after resection or sorafenib for hepatocellular carcinoma may differ between various hospital types.
authors.affiliation: Department of Registration and Research, Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands.
authors.forename: Lydia G M
authors.initials: LG
authors.lastname: van der Geest
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: van Meer
authors.affiliation: Department of Registration and Research, Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands.
authors.forename: Janina G H
authors.initials: JG
authors.lastname: Schrier
authors.affiliation: Departments of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Heinz-Josef
authors.initials: HJ
authors.lastname: Klümpen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands. Electronic address: k.j.vanerpecum@umcutrecht.nl.
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
authors.affiliation: Departments of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Man
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006761:Hospitals / Q000145:classification*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D000077157:Sorafenib; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib