Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Dallas VA Medical Center, Department of Veterans Affairs, Dallas, TX, USA.
Ann Surg Oncol. 2022 Sep;29(9):5488-5497. doi: 10.1245/s10434-022-11897-3. Epub 2022 May 22.
The incidence of hepatocellular carcinoma (HCC) has substantially increased over the last two decades within the Veteran Affairs Health System (VAHS). This study aims to describe the temporal trend of early-stage HCC (ES-HCC) treatment in the VAHS and identify patient/hospital factors associated with treatment disparities.
VA Corporate Data Warehouse was used to identify patients diagnosed with ES-HCC (stages I/II) from 2001 to 2015. Initial course of therapy was categorized as curative treatment (CT), noncurative treatment (NCT), or no treatment (NT). Univariate logistic regression and stepwise multivariate logistic regression models were used to analyze factors associated with receipt of treatment (CT/NCT) versus NT and receipt of CT versus NCT.
Our study included 9504 patients (15% CT, 51% NCT, and 34% NT). During the study period, the rate of overall treatment increased, while the rate of CT decreased (p < 0.001). Stage II, age > 65 years, presence of non-alcoholic fatty liver disease (NAFLD), Child-Pugh C, higher Model for End-Stage Liver Disease (MELD) score, platelets < 100,000/mm, low hospital complexity score, and Southwest location were significantly associated with higher rates of NT (all p < 0.05). Factors significantly associated with decreased utilization of CT included Hispanic race, lower hospital complexity score, and treatment in the Midwest, West, or Southeast regions (all p < 0.05).
There is a significant trend toward increased overall treatment utilization with decreased use of curative-intent approaches for ES-HCC in the national veteran population, and significant hospital and regional disparities exist. Further characterization and investigation of these factors may facilitate implementation of interventions to improve treatment utilization for the veteran population with HCC.
在过去的二十年中，退伍军人事务部医疗系统（VAHS）中肝细胞癌（HCC）的发病率大幅上升。本研究旨在描述 VAHS 中早期 HCC（ES-HCC）治疗的时间趋势，并确定与治疗差异相关的患者/医院因素。
使用 VA 公司数据仓库从 2001 年至 2015 年期间确定诊断为 ES-HCC（I/II 期）的患者。初始治疗方案分为根治性治疗（CT）、非根治性治疗（NCT）或未治疗（NT）。采用单变量逻辑回归和逐步多变量逻辑回归模型分析与接受治疗（CT/NCT）与 NT 以及接受 CT 与 NCT 相关的因素。
本研究纳入了 9504 例患者（15%为 CT，51%为 NCT，34%为 NT）。在研究期间，总体治疗率增加，而 CT 率下降（p<0.001）。II 期、年龄>65 岁、非酒精性脂肪性肝病（NAFLD）、Child-Pugh C、较高的终末期肝病模型（MELD）评分、血小板<100,000/mm、较低的医院复杂程度评分和西南部地区与更高的 NT 率显著相关（均 p<0.05）。与 CT 使用率降低显著相关的因素包括西班牙裔、较低的医院复杂程度评分以及在中西部、西部或东南部地区接受治疗（均 p<0.05）。
在全国退伍军人人群中，ES-HCC 的整体治疗利用率呈显著上升趋势，而根治性治疗方法的使用率却呈下降趋势，且存在显著的医院和地区差异。进一步对这些因素进行特征描述和研究可能有助于实施干预措施，以提高退伍军人 HCC 患者的治疗利用率。
