Faculty Collaboration Database

Primary Liver Cancer: An NCDB Analysis of Overall Survival and Margins After Hepatectomy. Ann Surg Oncol 2020 Apr;27(4):1156-1163

Date

11/05/2019

Pubmed ID

31677109

DOI

10.1245/s10434-019-07843-5

Scopus ID

2-s2.0-85074715626 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) constitute the majority of primary liver cancers. This retrospective review aimed to determine whether site of care is a significant predictor of patient outcome after hepatectomy as measured by overall survival, hazard ratios (HRs), and resection margin status.

METHODS: Data regarding patients with a new diagnosis of ICC and HCC who underwent hepatectomy were analyzed from the national cancer database. The patients were divided into two cohorts: those receiving treatment at academic cancer centers (ACCs) and those receiving treatment at community cancer centers (CCCs). The study adjusted for confounding variables and selection bias using propensity score matching. Median overall survival (months), hazard ratios, and resection margin status (R0, R1/R2, unknown) were examined.

RESULTS: The inclusion criteria were met by 10,463 patients. After propensity matching, 5600 patients remained, with half receiving treatment at ACCs and half at CCCs. Median overall survival from the date of diagnosis for patients undergoing hepatectomy was longer at ACCs than at CCCs (28.3 vs 24.8 months; p < 0.001). Additionally, multivariable Cox proportional hazards models showed that treatment at CCCs was associated with poorer survival than treatment at ACCs (HR, 1.226; 95% confidence interval [CI], 1.142-1.316; p < 0.0001). Treatment facility designation also was a predictive indicator of resection margin status, with patients at CCCs exhibiting higher odds of R1/R2 resections (odds ratio [OR], 1.41; 95% CI, 1.19-1.67; p < 0.0001).

CONCLUSION: Hepatectomy for ICC and HCC performed at ACCs was associated with improved outcomes compared with CCCs. Centralization of care to ACCs may lead to improved patient outcomes.

Author List

Coon C, Berger N, Eastwood D, Tsai S, Christians K, Mogal H, Clarke C, Gamblin TC

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Aged
Carcinoma, Hepatocellular
Cholangiocarcinoma
Female
Hepatectomy
Hospitals, Community
Humans
Liver Neoplasms
Male
Margins of Excision
Middle Aged
Propensity Score
Retrospective Studies
Survival Analysis
Survival Rate
United States