Monday, March 21, 2011

Predictors of Surgical Intervention for Hepatocellular Carcinoma


Predictors of Surgical Intervention for Hepatocellular Carcinoma
Race, Socioeconomic Status, and Hospital Type

Yulia Zak, MD; Kim F. Rhoads, MD, MS, MPH; Brendan C. Visser, MD

Arch Surg. Published online March 21, 2011. doi:10.1001/archsurg.2011.37

Objectives To define current use of surgical therapies for hepatocellular carcinoma (HCC) and evaluate the correlation of various patient and hospital characteristics with the receipt of these interventions.

Design Retrospective cohort.

Setting California Cancer Registry data linked to the Office of Statewide Health Planning and Development patient discharge abstracts between 1996 and 2006.

Patients Patients with primary HCC.

Main Outcome Measures Receipt of liver transplant, hepatic resection, or local ablation.

Results Of 12 148 HCC cases, 2390 (20%) underwent surgical intervention. Three hundred eleven (2.56%) received a liver transplant, 1307 (10.8%) underwent resection, and 772 (6.35%) had local ablation. There were wide variations in treatment by race and hospital type. African American and Hispanic patients were less likely than white patients to undergo transplant (P less then .05). African American and Hispanic patients were less likely than white and Asian/Pacific Islander patients to have hepatectomy or ablation (P less then .05). In multivariable analysis, the apparent differences in surgical intervention by race/ethnicity were decreased when adjusting for the patients' socioeconomic and insurance statuses. Patients with lower socioeconomic status and no private insurance were less likely to receive any surgery (P less then .01). Hospital characteristics also explained some variations. Disproportionate Share Hospitals and public, rural, and nonteaching hospitals were less likely to offer surgical treatment (P less then .01).

Conclusion There are significant racial, socioeconomic, and hospital-type disparities in surgical treatment of HCC.

Author Affiliations: Department of Surgery, Stanford University Medical Center, Stanford, California.

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