1Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut.
2Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, and.
J Natl Compr Canc Netw. 2020 Jun;18(6):729-736. doi: 10.6004/jnccn.2020.7529.
Transplantation, surgical resection, radiofrequency ablation, and percutaneous ethanol injection are generally considered potentially curative treatments for patients with hepatocellular carcinoma (HCC). With the increasing incidence of HCC, it is critical to investigate geographic variations in curative treatments and their associations with survival among patients.
A total of 6,782 patients with HCC during 2004 to 2011 were identified in the SEER-Medicare linked database and placed in quartiles based on the proportions undergoing potentially curative treatments per hospital referral region (HRR). Hierarchical Cox proportional hazards models were used to examine the association between regional potentially curative treatment patterns and survival across quartiles.
An average of 16.9% of patients with HCC underwent potentially curative treatments during 2004 to 2011, varying substantially from 0% to 34.5% across HRRs. Compared with patients residing in the lowest-quartile regions, those in the highest-quartile regions were more likely to be of other races (vs white or black), be infected with hepatitis B virus, and have more comorbidities. The 5-year survival was 4.7% in the lowest-quartile regions and 11.4% in the highest-quartile regions (P<.001). After controlling for confounders, patients in the highest-quartile regions had a lower risk of mortality (adjusted hazard ratio, 0.78; 95% CI, 0.72-0.85).
Patients with HCC who resided in HRRs with higher proportions of potentially curative treatments had better survival. Given its proven survival benefits, prompt clinical and policy actions are needed to reduce variations in treatment utilization.
肝移植、手术切除、射频消融和经皮乙醇注射通常被认为是治疗肝细胞癌（HCC）患者的潜在根治性治疗方法。随着 HCC 发病率的增加，研究根治性治疗方法的地域差异及其与患者生存的关系至关重要。
在 SEER-Medicare 关联数据库中，共确定了 2004 年至 2011 年期间的 6782 例 HCC 患者，并根据每个医院转诊区（HRR）接受潜在根治性治疗的比例将其分为 quartiles。分层 Cox 比例风险模型用于检查跨 quartiles 区域潜在的根治性治疗模式与生存之间的关联。
2004 年至 2011 年期间，平均有 16.9%的 HCC 患者接受了潜在的根治性治疗，HRR 之间的差异从 0%到 34.5%不等。与居住在最低 quartile 地区的患者相比，居住在最高 quartile 地区的患者更有可能是其他种族（非白种人或黑种人），感染乙型肝炎病毒，并有更多的合并症。最低 quartile 地区的 5 年生存率为 4.7%，而最高 quartile 地区的 5 年生存率为 11.4%（P<.001）。在控制混杂因素后，最高 quartile 地区的患者死亡风险较低（调整后的危险比，0.78；95%CI，0.72-0.85）。
居住在 HRR 中接受潜在根治性治疗比例较高的 HCC 患者的生存状况较好。鉴于其具有明显的生存获益，需要采取及时的临床和政策行动来减少治疗利用的差异。
