Treatment Patterns and Outcomes in Patients With Hepatocellular Carcinoma Stratified by Stage-Guided Treatment Categories.
OBJECTIVE
The purpose of this study was to assess the survival and treatment patterns of hepatocellular carcinoma (HCC) stratified by the NCCN stage-guided treatment categories in the absence of a universally accepted staging system for HCC.


METHODS
Patients with HCC were identified using ICD-9 codes and inclusion in the Huntsman Cancer Institute tumor registry. Patients were stratified by the NCCN groupings around the time of diagnosis as potentially resectable or operable (RESECT), potentially transplantable (TRANSP), unresectable (UNRESECT), inoperable due to performance status (INOPER), or having metastatic (METAST) disease. Survival and treatment patterns were assessed by NCCN stage-guided treatment categories.


RESULTS
A total of 221 patients (72.9% men) with HCC were identified. At the time of diagnosis, patients were categorized as RESECT (n=28, 12.7%), TRANSP (n=33, 14.9%), UNRESECT (n=77, 34.8%), INOPER (n=40, 18.1%), and METAST (n=38, 17.2%). Staging information was not specified for 5 patients (2.3%) even after chart review. Kaplan-Meier analysis demonstrated significant differences in survival between RESECT and UNRESECT categories, and between UNRESECT and METAST categories. The median survivals in RESECT, TRANSP, UNRESECT, INOPER, and METAST categories were 594, 562, 247, 167, and 44 days, respectively. Patients considered RESECT most frequently underwent resection (61%, n=17) and patients considered TRANSP had the highest use of liver transplants (33.3%, n=11). Use of any treatment was low in the METAST (31.6%, n=12) and INOPER (60.0%, n=24) groups.


CONCLUSIONS
Treatment patterns in the NCCN groupings correlated with recommended treatment strategies. Overall, the NCCN groupings have a linear relationship in overall survival.
From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah.
Kuan-Ling
KL
Kuo
From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah. From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah.
David
D
Stenehjem
From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah.
Frederick
F
Albright
From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah.
Saurabh
S
Ray
From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah. From Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah; AbbVie Inc., North Chicago, Illinois; and University of Utah Program in Personalized Health Care, Salt Lake City, Utah.
Diana
D
Brixner
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome