HSR20-079: Geographic Variations of Potentially Curative Treatments for Hepatocellular Carcinoma in the United States: A SEER-Medicare Study

Background: Transplantation, surgical resection, radiofrequency ablation, and percutaneous ethanol injection are generally considered as potentially curative treatments for patients of hepatocellular carcinoma (HCC). With the increasing incidence of HCC, it is critical to investigate geographic variations in HCC curative treatments and their associations with survival among HCC patients. Methods: Analyzing the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified 6,782 patients with HCC during 2004-2011. We created quartiles by the proportions of patients undergoing potentially curative treatments per hospital referral region (HRR). Hierarchical Cox proportional-hazards models were used to examine the association between regional potentially curative treatment patterns and survivals across quartiles. Results: An average of 16.9% of HCC patients underwent potential curative treatments during 2004-2011, varying substantially from 0% to 34.5% across HRRs. Compared to patients residing in the lowest-quartile regions, patients in the highest-quartile regions were more likely to be other races (vs. White or Black), be infected with Hepatitis B, and have more comorbidities. The 5-year survival was 4.7% in the lowest-quartile regions and 11.4% in the highest-quartile regions (P-value <0.001). After controlling for confounders, patients in the highest-quartile regions had a lower risk of mortality (adjusted hazard ratio 0.78; 95% confidence interval: 0.72-0.85). Conclusion: HCC patients who resided in HRRs with higher proportions of potentially curative treatments had better survivals. Given its proven survival benefits, prompt clinical and policy actions are needed to reduce variations in treatment utilization.

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Corresponding Author: En Cheng, MD, MSPH
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