Division of Gastroenterology and Hepatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine, Chiangmai University, Bangkok, Thailand.
Asian Pac J Cancer Prev. 2022 Nov 1;23(11):3701-3715. doi: 10.31557/APJCP.2022.23.11.3701.
Hepatocellular carcinoma (HCC) is one of the commonest cancers in Thailand. We report the stage and survival of patients who were admitted under the public universal health fund (NHSO) covering 47 million people to determine if there were regional disparities in the treatment outcomes in the country.
We used the 2009-2013 Nationwide Hospital Admission Data, Thailand. Patients with hepatocellular carcinoma (HCC) were identified by the ICD10 code C22.0. Procedures were identified by ICD9-CM codes, and deaths were confirmed from the NHSO database and the national citizen registry. Thailand is divided into 6 regions and Bangkok. Hospitals were identified according to their specific reimbursement codes. Survival time started from the day of first admission and was estimated using the Kaplan-Meier method. The statistical method used to compare regions was Chi-squared tests (Pearson, likelihood ratio, linear-by linear association and Mantel-cox).
There were 36,956 HCC patients admitted during the study period. The overall median survival was 36 days. 1.63% of the patients had surgery, 0.96% had radiofrequency ablation (RFA), and 5.24% had trans-arterial chemoembolization (TACE). 90.24% did not have any tumor-specific therapy. The proportion of patients admitted for tumor-specific therapy vs. no tumor-specific therapy was significantly different between regions in all treatment modalities (p<0.01). Each treatment modality showed a wide range of median survival values across the regions (p<0.01). The best survival was seen in Bangkok, the South and the North (for surgery, RFA and TACE) and was often more than twice as long as the regions with the lowest survival, Central, East and West.
There was a large previously-unreported disparity in admissions and outcomes in Thailand for different treatment modalities for HCC. Bangkok and the South had the best treatment outcomes and often had median survivals more than twice as long as those in the West and East. Public policy to reduce this disparity will need to be implemented in the future.
肝细胞癌（HCC）是泰国最常见的癌症之一。我们报告了在覆盖 4700 万人的公共全民健康基金（NHSO）下入院的患者的分期和生存情况，以确定该国在治疗结果方面是否存在区域差异。
我们使用了 2009-2013 年泰国全国住院数据。通过国际疾病分类第 10 版（ICD10）代码 C22.0 识别肝细胞癌（HCC）患者。通过国际疾病分类第 9 版-临床修正（ICD9-CM）代码识别手术程序，并从 NHSO 数据库和国家公民登记处确认死亡。泰国分为 6 个地区和曼谷。根据其特定的报销代码确定医院。生存时间从首次入院的那天开始，并使用 Kaplan-Meier 方法进行估计。用于比较区域的统计方法是卡方检验（Pearson、似然比、线性-线性关联和 Mantel-cox）。
研究期间共收治 36956 例 HCC 患者。总体中位生存时间为 36 天。有 1.63%的患者接受了手术，0.96%接受了射频消融（RFA），5.24%接受了经动脉化疗栓塞（TACE）。90.24%的患者未接受任何肿瘤特异性治疗。在所有治疗方式中，接受肿瘤特异性治疗与未接受肿瘤特异性治疗的患者比例在不同地区之间存在显著差异（p<0.01）。每个治疗方式在各个地区的中位生存值差异较大（p<0.01）。曼谷、南部和北部（手术、RFA 和 TACE）的生存情况最好，往往是生存情况最差的中部、东部和西部的两倍以上。
在泰国，不同 HCC 治疗方式的入院和结果存在大量以前未报告的差异。曼谷和南部地区的治疗效果最好，中位生存期往往是西部和东部地区的两倍以上。未来需要实施公共政策来减少这种差异。
