The Effect of Bridging Locoregional Therapy and Sociodemographics on Survival in Hepatocellular Carcinoma Patients Undergoing Orthotopic Liver Transplantation: A United Network for Organ Sharing Population Study.
OBJECTIVE
To investigate socioeconomic and demographic factors associated with transplantation outcomes in patients with hepatocellular carcinoma (HCC) treated with bridging locoregional therapy (LRT) before orthotopic liver transplantation (OLT).


METHODS
The United Network for Organ Sharing (UNOS) database was used to identify all patients in the United States with HCC who were listed for OLT between 2002 and 2013. Mean overall survival (OS) after OLT was stratified based on age, sex, ethnicity, transplant year, region, and insurance status. Kaplan-Meier estimation was used for survival analysis with log-rank test and Cox proportional hazards model to assess independent prognostic factors for OS.


RESULTS
Of the 17,291 listed patients with HCC, 14,511 underwent OLT. Mean age was 57.4 years (76.8% male). Favorable sociodemographic factors were associated with increased rates of bridging LRT before OLT and longer wait time on the transplant list and were shown to be independent prognostic factors for prolonged OS after OLT using multivariate analysis. Favorable demographic factors included patient age < 60 years, donor age < 45 years, year of diagnosis between 2008 and 2013, UNOS regions 4 and 5, Asian ethnicity, high functional status, postgraduate education, private payer insurance, and employment at the time of OLT.


CONCLUSIONS
Patients with favorable sociodemographics had higher rates of LRT before OLT performed for HCC cure. These patients had longer transplant wait times and longer OS after OLT.
Departments of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Michael J
MJ
Magnetta
Division of Interventional Radiology, Department of Radiology, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT 06510.
Minzhi
M
Xing
Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
Di
D
Zhang
Departments of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Interventional Radiology, Department of Radiology, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT 06510; Yale Cancer Center, New Haven, Connecticut.. Electronic address: kevin.kim@yale.edu.
Hyun S
HS
Kim
D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004334:Drug Administration Schedule; D004522:Educational Status; D004651:Employment; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists
D000970:Antineoplastic Agents