TY - JOUR
T1 - Variation of Hepatocellular Carcinoma Treatment Patterns and Survival Across Geographic Regions in a Veteran Population
AU - Ju, Michelle R.
AU - Karalis, John D.
AU - Chansard, Matthieu
AU - Augustine, M. Mathew
AU - Mortensen, Eric
AU - Wang, Sam C.
AU - Porembka, Matthew R.
AU - Zeh, Herbert J.
AU - Yopp, Adam C.
AU - Polanco, Patricio M.
N1 - Funding Information:
John D. Karalis was supported by a Physician-Scientist Institutional Award from the Burroughs Wellcome Fund (award no. 1018897). Work by Patricio M. Polanco was supported by the New Investigator Award Program of the North Texas VA Health Care System and the Eugene P. Frenkel, M.D. Scholar in Clinical Medicine Program of UT Southwestern.
Publisher Copyright:
© 2022, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Veteran populations have five times the incidence of hepatocellular carcinoma (HCC) compared with the general population. The incidence of HCC has increased in the Veteran’s Affairs Health System (VAHS), primarily due to the increased prevalence of cirrhosis. This study aimed to characterize differences in treatment patterns and overall survival rates across the five VAHS geographic regions. Methods: Using the VA Corporate Data Warehouse, the authors built a comprehensive national dataset of Veteran patients with HCC diagnosed between 2001 and 2015 to compare patients across VAHS regions. A multivariable Cox proportional hazards model was used to identify factors associated with 5-year all-cause mortality. Kaplan-Meier curves were used to visualize the patient survival function, and the log-rank test was applied to test statistical significance. Results: This retrospective study analyzed 13,434 patients. The West region had the highest rate of overall treatment receipt (63.6%), and the Southwest had the lowest rate (52.9%). After adjustment for demographic, clinicopathologic, treatment, and hospital factors, treatment in a non-West region continued to be significantly associated with a 10% to 13% increased risk of 5-year mortality (Midwest: hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.03–1.17; Northeast: HR, 1.10; 95% CI, 1.03–1.17; Southeast: HR, 1.13; 95% CI, 1.06–1.21; Southwest: HR, 1.11; 95% CI, 1.03–1.19) (p < 0.01). Conclusions: Treatment patterns and overall survival rates of HCC patients differ significantly across VAHS geographic regions. Targeted interventions to increase the rate of treatment in the non-West regions are needed to improve survival of HCC Veterans and provide uniformly high-quality care across VAHS facilities.
AB - Background: Veteran populations have five times the incidence of hepatocellular carcinoma (HCC) compared with the general population. The incidence of HCC has increased in the Veteran’s Affairs Health System (VAHS), primarily due to the increased prevalence of cirrhosis. This study aimed to characterize differences in treatment patterns and overall survival rates across the five VAHS geographic regions. Methods: Using the VA Corporate Data Warehouse, the authors built a comprehensive national dataset of Veteran patients with HCC diagnosed between 2001 and 2015 to compare patients across VAHS regions. A multivariable Cox proportional hazards model was used to identify factors associated with 5-year all-cause mortality. Kaplan-Meier curves were used to visualize the patient survival function, and the log-rank test was applied to test statistical significance. Results: This retrospective study analyzed 13,434 patients. The West region had the highest rate of overall treatment receipt (63.6%), and the Southwest had the lowest rate (52.9%). After adjustment for demographic, clinicopathologic, treatment, and hospital factors, treatment in a non-West region continued to be significantly associated with a 10% to 13% increased risk of 5-year mortality (Midwest: hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.03–1.17; Northeast: HR, 1.10; 95% CI, 1.03–1.17; Southeast: HR, 1.13; 95% CI, 1.06–1.21; Southwest: HR, 1.11; 95% CI, 1.03–1.19) (p < 0.01). Conclusions: Treatment patterns and overall survival rates of HCC patients differ significantly across VAHS geographic regions. Targeted interventions to increase the rate of treatment in the non-West regions are needed to improve survival of HCC Veterans and provide uniformly high-quality care across VAHS facilities.
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U2 - 10.1245/s10434-022-12390-7
DO - 10.1245/s10434-022-12390-7
M3 - Article
C2 - 36018517
AN - SCOPUS:85136709347
SN - 1068-9265
VL - 29
SP - 8413
EP - 8420
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 13
ER -