title: Analysis of liver-directed therapies in U.S. cancer patients.
abstract: BACKGROUND
  The liver is a common site of primary and metastatic cancer. Liver-directed therapies are commonly used to treat cancer involving the liver. We report on the patterns, predictors, and outcomes of liver-directed therapies in hospitalized cancer patients in the United States.
  
  
  METHODS
  Data were obtained from all U.S. states that contributed to the Nationwide Inpatient Sample maintained by the Agency for Healthcare Research and Quality between 2006 and 2010. Univariate and multivariate testing was used to identify factors significantly associated with patient outcome.
  
  
  RESULTS
  For the 5-year period of interest, 12,540 patient discharges were identified. Mean age in the sample was 60 years. Primary liver lesions (n = 8840) made up 26.9% of the sample; the remaining cases were metastases. Most procedures were performed in large (79%) urban (98%) hospitals and in patients with insurance (97.9%). The most common intervention was partial hepatectomy (42.7%), followed by open (9.9%), percutaneous (7.2%), and laparoscopic (5.04%) ablation of liver lesions; embolization (9.8%); and liver transplantation (2.64%). The incidence of in-hospital mortality was very low (2.4%), and the complication rate was 12.2%. Complications such as acute liver necrosis, ascites, hepatic coma, hepatorenal syndrome, liver abscess, and high number of comorbid illnesses (>8) accounted for 60% of the in-hospital mortality.
  
  
  CONCLUSIONS
  The low rate of morbidity and mortality associated with liver-directed therapies in hospitalized cancer patients supports the continuing utility of such procedures in the management of primary and metastatic liver cancer. The patterns of health disparities observed with respect to the use of liver-directed therapies are concerning.
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, U.S.A.;
authors.forename: O B
authors.initials: OB
authors.lastname: Alese
authors.affiliation: Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A.;
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, U.S.A.
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, U.S.A.;
authors.forename: S S
authors.initials: SS
authors.lastname: Ramalingam
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, U.S.A.;
authors.forename: T K
authors.initials: TK
authors.lastname: Owonikoko
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, U.S.A.;
authors.forename: B F
authors.initials: BF
authors.lastname: El-Rayes
keywords: Liver; hospitalization; outcomes; predictors; therapies