title: Palliative interventions for hepatocellular carcinoma patients: analysis of the National Cancer Database.
abstract: BACKGROUND
  Palliative therapies are provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of providing symptomatic relief, better quality of life and improved survival. The present study sought to assess and compare the efficacy of different palliative therapies for HCC.
  
  
  METHODS
  The National Cancer Database (NCDB), a retrospective national database that captures approximately 70% of all patients treated for cancer in the US, was queried for patients with HCC who were deemed unresectable from 1998-2011. Patients were stratified by receipt of palliative therapy. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival.
  
  
  RESULTS
  A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy (RT), 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain management therapy, while 209 (6.4%) received a combination of the previous three modalities. On multivariate analysis palliative RT was identified as a positive predictor of survival [hazards ratio (HR) 0.65; 95% CI, 0.50-0.83]. Stratifying by disease stage, palliative RT provided a significant survival benefit for patients with stage IV disease.
  
  
  CONCLUSIONS
  Palliative RT appears to extend survival and should be considered for patients presenting with late stage HCC.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Abdulrahman Y
authors.initials: AY
authors.lastname: Hammad
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Robbins
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. fjohnst4@jhmi.edu.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D059408:Pain Management; D010166:Palliative Care; D016016:Proportional Hazards Models; D011878:Radiotherapy; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins
keywords:  National Cancer Database (NCDB); Liver neoplasms; hepatocellular carcinoma (HCC); palliative therapy; radiotherapy (RT)