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. 2013 Sep 1;11(9):1101-8.
doi: 10.6004/jnccn.2013.0131.

Therapeutic delays lead to worse survival among patients with hepatocellular carcinoma

Amit G Singal  1 , Akbar K Waljee, Nishant Patel, Emerson Y Chen, Jasmin A Tiro, Jorge A Marrero, Adam C Yopp
Affiliations

Therapeutic delays lead to worse survival among patients with hepatocellular carcinoma

Amit G Singal et al. J Natl Compr Canc Netw. .

Abstract

Although prior studies have shown underuse of appropriate therapy in patients with hepatocellular carcinoma (HCC), no studies to date have assessed the prevalence and clinical impact of therapeutic delays among patients with HCC. The goal of this study was to characterize and identify factors associated with underuse and delays in treatment of these patients. A retrospective cohort study was conducted of patients with cirrhosis diagnosed with HCC at a large urban safety net hospital between January 2005 and June 2012. Dates for HCC diagnosis and any treatments were recorded. Univariate and multivariate analysis was used to determine factors associated with treatment underuse and delayed treatment, which was defined as time from diagnosis to treatment exceeding 3 months. The authors identified 267 treatment-eligible patients with HCC, of whom only 62% received HCC therapy. On multivariate analysis, tumor stage (odds ratio [OR], 0.48; 95% CI, 0.36-0.65), Child-Pugh class (OR, 0.49; 95% CI, 0.28-0.84), and black race (OR, 0.55; 95% CI, 0.31-0.99) were associated with lower rates of treatment use. The median time to treatment was 1.7 months, with 31% of patients experiencing delayed treatment. Delayed treatment was associated with the presence of ascites (hazard ratio [HR], 2.8; 95% CI, 1.3-6.1) and current treatment with transarterial chemoembolization (HR, 4.8; 95% CI, 1.8-12.5). After adjusting for tumor stage and Child-Pugh class, treatment underuse (HR, 0.33; 95% CI, 0.24-0.46) and delayed treatment (HR, 0.50; 95% CI, 0.30-0.84) were both associated with significantly worse survival. Results showed that, in addition to one-third of patients not receiving HCC-directed therapy, another 30% experienced significant therapeutic delays, leading to worse survival.

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Conflict of interest statement

The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.

Figures

Figure 1
Figure 1
Overall survival, stratified by treatment use (adjusted for Barcelona Clinic Liver Cancer tumor stage and Child-Pugh class). Abbeviation: HR, hazard ratio.
Figure 2
Figure 2
Overall survival, stratified by the presence of treatment delays (adjusted for Barcelona Clinic Liver Cancer tumor stage and Child-Pugh class). Abbreviation: HR, hazard ratio.
See this image and copyright information in PMC

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References

    1. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–2576. - PubMed
    1. Singal AG, Marrero JA. Recent advances in the treatment of hepatocellular carcinoma. Curr Opin Gastroenterol. 2010;26:189–195. - PubMed
    1. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2010;53:1–35. - PMC - PubMed
    1. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009;27:1485–1491. - PMC - PubMed
    1. Singal A, Volk ML, Waljee A, et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther. 2009;30:37–47. - PMC - PubMed

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