Disparities in care for patients with curable hepatocellular carcinoma.
BACKGROUND
The incidence of hepatocellular carcinoma (HCC) is increasing, but surgical management continues to be underutilized. This retrospective review investigates treatment decisions and survival for early stage HCC.


METHODS
The National Cancer Database (NCDB) was queried for all patients with curable HCC (Stage I/II) from 1998 to 2011 (n = 43 859). Patient and tumour characteristics were analysed to determine predictors of having surgery and of long-term survival.


RESULTS
Only 39.7% of patients received surgery for early stage HCC. Surgical therapies included resection (34.6%), transplant (28.7%), radiofrequency ablation (27.1%) and other therapies. Surgery correlated with improved median survival (48.3 versus 8.4 months), but was only performed on 42% of stage I patients and 50% of tumours smaller than 2 cm. Patients were more likely to receive surgery if they were Asian or white race, had private insurance, higher income, better education, or treatment at an academic centre (P < 0.05). However, private insurance and treatment at an academic centre were the only variables associated with improved survival (P < 0.05).


CONCLUSIONS
Fewer than half of patients with curable HCC receive surgery, possibly as a result of multiple socioeconomic variables. Past these barriers to care, survival is related to adequate and reliable treatment. Further efforts should address these disparities in treatment decisions.
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Richard S
RS
Hoehn
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Dennis J
DJ
Hanseman
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Peter L
PL
Jernigan
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Koffi
K
Wima
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Audrey E
AE
Ertel
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Daniel E
DE
Abbott
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Shimul A
SA
Shah
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology