Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
J Gastroenterol Hepatol. 2019 Mar;34(3):575-579. doi: 10.1111/jgh.14515. Epub 2018 Nov 18.
Geographic differences have existed in the management of hepatocellular carcinoma (HCC), and efforts to reduce regional disparities have been initiated. The aim of this study is to use the Nationwide Inpatient Sample to determine if regional disparities in the treatment of HCC continue to exist.
A retrospective database analysis using the Nationwide Inpatient Sample was performed that included patients with a primary diagnosis of HCC. Logistic regression models were utilized to determine geographic disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.
This study's locational reach of 62 604 patients included 22 769 patients from the South (36%), 14 554 in the Northeast (23%), 14 041 in the West (22%), and 11 240 in the Midwest (18%). Patients who received treatment in the West were more likely to have inpatient mortality (OR 1.28, 95% CI 1.03, 1.53) than patients who received treatment in the Midwest. No significant differences were observed between rates of resection, ablation, and transarterial chemoembolization when comparing by region. Rates of liver transplantation were lower in the West compared with the Midwest (OR 0.51, 95% CI 0.29, 0.87). There was no significant difference between other regions.
Geographic disparities in the treatment of HCC are improving.
肝细胞癌（HCC）的治疗存在地域差异，为减少地域差异已开展相关工作。本研究旨在利用全国住院患者样本（Nationwide Inpatient Sample，NIS）确定 HCC 治疗的地域差异是否仍然存在。
使用 NIS 进行回顾性数据库分析，纳入 HCC 主要诊断的患者。采用 logistic 回归模型确定肝失代偿、治疗、住院死亡率和转移性疾病的地域差异。
本研究的地域范围涉及 62604 例患者，其中南方患者 22769 例（36%）、东北患者 14554 例（23%）、西部患者 14041 例（22%）和中西部患者 11240 例（18%）。与中西部地区相比，接受西部地区治疗的患者住院死亡率更高（OR 1.28，95%CI 1.03，1.53）。按地域比较时，手术切除、消融和经动脉化疗栓塞的比例没有显著差异。与中西部相比，西部地区的肝移植率较低（OR 0.51，95%CI 0.29，0.87）。其他地区之间无显著差异。
HCC 治疗的地域差异正在改善。
