Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Cancer. 2010 Apr 1;116(7):1801-9. doi: 10.1002/cncr.24936.
: Patients with hepatocellular carcinoma (HCC) have a poor prognosis if their tumors are not diagnosed early. The authors investigated factors associated with the receipt of liver transplant among patients with HCC and evaluated the effects of these differences on survival.
: The authors reviewed records from consecutive patients diagnosed with HCC at Columbia University Medical Center from January 1, 2002 to September 1, 2008. We compared patient clinical and demographic characteristics, developed a multivariable logistic regression model of predictors of transplant, and used a Cox model to analyze predictors of mortality.
: Of 462 HCC patients, 175 (38%) received a transplant. Black patients were much less likely than whites to receive a transplant (odds ratio [OR], 0.03; 95% confidence interval [CI], 0.0-0.37). Hispanics and Asians were also less likely to undergo transplantation, but the differences were not statistically significant. Patients with private insurance were more likely to receive a transplant than those with Medicaid (odds ratio [OR], 22.07; 95% confidence interval [CI], 2.67-182.34). Black and Hispanic patients, and Medicaid recipients, presented with more advanced disease than whites and privately insured patients, and had poorer survival. In a Cox model, those who did not receive a transplant were 3 times as likely as transplant recipients to die, but race and insurance were not independently predictive of mortality.
: Race and insurance status were strongly associated with receipt of transplantation and with more advanced disease at diagnosis, but transplantation was the most important determinant of survival. Improved access to care for nonwhite and Medicaid patients may allow more patients to benefit from transplant. Cancer 2010. (c) 2010 American Cancer Society.
如果肝癌（HCC）患者的肿瘤不能早期诊断，其预后则较差。作者调查了与 HCC 患者接受肝移植相关的因素，并评估了这些差异对生存的影响。
作者回顾了 2002 年 1 月 1 日至 2008 年 9 月 1 日期间在哥伦比亚大学医学中心连续诊断为 HCC 的患者的病历。比较了患者的临床和人口统计学特征，建立了移植预测因素的多变量逻辑回归模型，并使用 Cox 模型分析了死亡率的预测因素。
在 462 例 HCC 患者中，175 例（38%）接受了移植。与白人相比，黑人患者接受移植的可能性低得多（比值比 [OR]，0.03；95%置信区间 [CI]，0.0-0.37）。西班牙裔和亚裔患者接受移植的可能性也较低，但差异无统计学意义。有私人保险的患者比有医疗补助（Medicaid）的患者更有可能接受移植（OR，22.07；95%CI，2.67-182.34）。黑人、西班牙裔和 Medicaid 患者的疾病比白人患者和私人保险患者更为晚期，且生存率较差。在 Cox 模型中，未接受移植的患者死亡的可能性是接受移植患者的 3 倍，但种族和保险并不是死亡率的独立预测因素。
种族和保险状况与接受移植和诊断时更晚期的疾病密切相关，但移植是生存的最重要决定因素。改善非裔和 Medicaid 患者的医疗服务获取途径可能使更多的患者受益于移植。癌症 2010。（c）2010 年美国癌症协会。
