Population Informatics Lab, Texas A&M University, College Station, Texas; Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, College Station, Texas.
Population Informatics Lab, Texas A&M University, College Station, Texas; Department of Industrial & Systems Engineering, Texas A&M University, College Station, Texas.
Clin Gastroenterol Hepatol. 2023 May;21(5):1281-1292.e10. doi: 10.1016/j.cgh.2022.07.031. Epub 2022 Aug 4.
BACKGROUND & AIMS: Failures have been reported across the cancer care continuum in patients with hepatocellular carcinoma (HCC); however, the impact of treatment delays on outcomes has not been well-characterized. We described the prevalence of treatment delays in a racially and ethnically diverse cohort of patients and its association with overall survival.
Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients diagnosed with HCC between 2001 and 2015. We performed multivariable logistic regression analysis to identify factors associated with treatment delay (ie, receipt of HCC-directed therapy >3 months after diagnosis). Cox proportional hazards regression analysis with a 5-month landmark was used to characterize the association between treatment delay and overall survival, accounting for immortal time bias.
Of 8450 patients with treatment within 12 months of HCC diagnosis, 1205 (14.3%) experienced treatment delays. The proportion with treatment delays ranged from 6.8% of patients undergoing surgical resection to 21.6% of those undergoing liver transplantation. In multivariable analysis, Black patients (odds ratio, 1.96; 95% confidence interval [CI], 1.21-3.15) and those living in high poverty neighborhoods (odds ratio, 1.55; 95% CI, 1.25-1.92) were more likely to experience treatment delays than white patients and those living in low poverty neighborhoods, respectively. Treatment delay was independently associated with worse survival (hazard ratio 1.15, 95% CI, 1.05-1.25).
Nearly 1 in 7 patients with HCC experience treatment delays, with higher odds in Black patients and those living in high poverty neighborhoods. Treatment delays are associated with worse survival, highlighting a need for interventions to improve time-to-treatment.
肝癌（HCC）患者在癌症治疗全过程中均出现治疗失败的情况，但治疗延迟对结局的影响尚未得到充分描述。我们描述了在一个种族和民族多样化的 HCC 患者队列中治疗延迟的发生率，并探讨其与总生存的关系。
我们使用监测、流行病学和最终结果-医疗保险数据库，确定了 2001 年至 2015 年间被诊断为 HCC 的患者。我们进行多变量逻辑回归分析，以确定与治疗延迟（即接受 HCC 定向治疗的时间比诊断后 3 个月长）相关的因素。使用带有 5 个月时间截点的 Cox 比例风险回归分析来描述治疗延迟与总生存之间的关系，以消除不朽时间偏倚。
在 12 个月内接受 HCC 治疗的 8450 例患者中，有 1205 例（14.3%）出现治疗延迟。接受手术切除的患者中治疗延迟的比例为 6.8%，而接受肝移植的患者中治疗延迟的比例为 21.6%。多变量分析显示，黑人患者（比值比，1.96；95%置信区间[CI]，1.21-3.15）和居住在高贫困社区的患者（比值比，1.55；95%CI，1.25-1.92）比白人患者和居住在低贫困社区的患者更有可能出现治疗延迟。治疗延迟与较差的生存独立相关（风险比 1.15，95%CI，1.05-1.25）。
近 1/7 的 HCC 患者出现治疗延迟，黑人患者和居住在高贫困社区的患者发生的可能性更高。治疗延迟与较差的生存相关，这突出表明需要采取干预措施来改善治疗时间。
