Primary Liver Cancer: An NCDB Analysis of Overall Survival and Margins After Hepatectomy.
Academic Medical Centers
/ statistics & numerical data
Aged
Carcinoma, Hepatocellular
/ mortality
Cholangiocarcinoma
/ mortality
Confounding Factors, Epidemiologic
Female
Hepatectomy
Hospitals, Community
/ statistics & numerical data
Humans
Liver Neoplasms
/ mortality
Male
Margins of Excision
Middle Aged
Propensity Score
Retrospective Studies
Survival Analysis
Survival Rate
United States
/ epidemiology
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
09
05
2019
pubmed:
5
11
2019
medline:
29
12
2020
entrez:
3
11
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 31677109
doi: 10.1245/s10434-019-07843-5
pii: 10.1245/s10434-019-07843-5
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1156-1163Références
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86. https://doi.org/10.1002/ijc.29210 .
doi: 10.1002/ijc.29210
pubmed: 25220842
Liver and Intrahepatic Bile Duct Cancer–Cancer Stat Facts. Retrieved 2 August 2018 at https://seer.cancer.gov/statfacts/html/livibd.html .
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al. (eds). SEER Cancer Statistics Review, 1975–2015, National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2015/ .
Petrick JL, Kelly SP, Altekruse SF, McGlynn KA, Rosenberg PS. Future of hepatocellular carcinoma incidence in the United States forecast through 2030. J Clin Oncol. 2016;34:1787–94. https://doi.org/10.1200/jco.2015.64.7412 .
doi: 10.1200/JCO.2015.64.7412
pubmed: 27044939
pmcid: 4966339
Buettner S, van Vugt JL, IJzermans JN, Groot Koerkamp B. Intrahepatic cholangiocarcinoma: current perspectives. OncoTargets Ther. 2017;10:1131–42. https://doi.org/10.2147/ott.s93629 .
doi: 10.2147/OTT.S93629
Fong ZV, Tanabe KK. The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: a comprehensive and evidence-based comparison and review. Cancer. 2014;120:2824–38. https://doi.org/10.1002/cncr.28730 .
doi: 10.1002/cncr.28730
pubmed: 24897995
Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–37. https://doi.org/10.1056/nejmsa1010705 .
doi: 10.1056/NEJMsa1010705
pubmed: 21631325
pmcid: 3150488
Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. Retrieved 2 August 2018, from http://dx.doi.org/10.1056/NEJMsa012337 . https://doi.org/10.1056/nejmsa012337 .
doi: 10.1056/NEJMsa012337
Enomoto LM, Gusani NJ, Dillon PW, Hollenbeak CS. Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2014;18:690–700. https://doi.org/10.1007/s11605-013-2422-z .
doi: 10.1007/s11605-013-2422-z
Chang C-M, Yin W-Y, Wei C-K, Lee C-H, Lee C-C. The combined effects of hospital and surgeon volume on short-term survival after hepatic resection in a population-based study. PloS One. 2014;9:e86444. https://doi.org/10.1371/journal.pone.0086444 .
doi: 10.1371/journal.pone.0086444
pubmed: 24466102
pmcid: 3899267
Schneider EB, Ejaz A, Spolverato G, et al. Hospital volume and patient outcomes in hepato-pancreatico-biliary surgery: is assessing differences in mortality enough? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2014;18:2105–15. https://doi.org/10.1007/s11605-014-2619-9 .
doi: 10.1007/s11605-014-2619-9
Hsu RCJ, Salika T, Maw J, Lyratzopoulos G, Gnanapragasam VJ, Armitage JN. Influence of hospital volume on nephrectomy mortality and complications: a systematic review and meta-analysis stratified by surgical type. BMJ Open. 2017;7:e016833. https://doi.org/10.1136/bmjopen-2017-016833 .
doi: 10.1136/bmjopen-2017-016833
pubmed: 28877947
pmcid: 5588977
Schrag D, Panageas KS, Riedel E, et al. Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol. 2003;83:68–78; discussion 78–79. https://doi.org/10.1002/jso.10244 .
doi: 10.1002/jso.10244
Schrag D, Earle C, Xu F, et al. Associations between hospital and surgeon procedure volumes and patient outcomes after ovarian cancer resection. J Natl Cancer Inst. 2006;98:163–171. https://doi.org/10.1093/jnci/djj018 .
doi: 10.1093/jnci/djj018
pubmed: 16449676
Lin H-C, Lin C-C. Surgeon volume is predictive of 5-year survival in patients with hepatocellular carcinoma after resection: a population-based study. J Gastrointest Surg. 2009;13:2284–91. https://doi.org/10.1007/s11605-009-0990-8 .
doi: 10.1007/s11605-009-0990-8
pubmed: 19730957
Gani F, Azoulay D, Pawlik TM. Evaluating trends in the volume–outcomes relationship following liver surgery: does regionalization benefit all patients the same? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2017;21:463–71. https://doi.org/10.1007/s11605-016-3316-7 .
doi: 10.1007/s11605-016-3316-7
Hyder O, Sachs T, Ejaz A, Spolverato G, Pawlik TM. Impact of hospital teaching status on length of stay and mortality among patients undergoing complex hepatopancreaticobiliary surgery in the USA. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2013;17:2114–22. https://doi.org/10.1007/s11605-013-2349-4 .
doi: 10.1007/s11605-013-2349-4
Lafaro K, Grandhi MS, Herman JM, Pawlik TM. The importance of surgical margins in primary malignancies of the liver. J Surg Oncol. 2016;113:296–303. https://doi.org/10.1002/jso.24123 .
doi: 10.1002/jso.24123
pubmed: 26659586
National Cancer Database. American College of Surgeons. Retrieved 1 August 2018 at https://www.facs.org/quality-programs/cancer/ncdb .
American College of Surgeons. Quality Programs. National Cancer Database. Participant User Files. Version: PUF 2014. Retrieved 2 August 2018 from https://www.facs.org/~/media/files/quality%20programs/cancer/ncdb/puf%20data%20dictionary%20version%20puf%202014.ashx .
Kosanke, J., Bergstralh, E. (2004, March). Division of Biomedical Statistics and Informatics—Mayo Clinic Research. Retrieved 6 June 2016, from http://bioinformaticstools.mayo.edu/research/vmatch/ .
Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51. https://doi.org/10.1001/jama.280.20.1747 .
doi: 10.1001/jama.280.20.1747
Aquina CT, Probst CP, Becerra AZ, et al. High volume improves outcomes: the argument for centralization of rectal cancer surgery. Surgery. 2016;159:736–48. https://doi.org/10.1016/j.surg.2015.09.021 .
doi: 10.1016/j.surg.2015.09.021
pubmed: 26576696
Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med Care. 2010;48:1041. https://doi.org/10.1097/mlr.0b013e3181f37d5f .
doi: 10.1097/MLR.0b013e3181f37d5f
pubmed: 20966781
Simunovic M, Rempel E, Thériault M-E, et al. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg. 2006;49:251–8.
pubmed: 16948883
pmcid: 3207572
Gooiker GA, Gijn W van, Wouters MWJM, Post PN, Velde CJH van de, Tollenaar R a. EM. Systematic review and meta-analysis of the volume–outcome relationship in pancreatic surgery. BJS. 2011;98:485–94. https://doi.org/10.1002/bjs.7413 .
doi: 10.1002/bjs.7413
Buettner S, Gani F, Amini N, et al. The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery. 2016;159:1004–12. https://doi.org/10.1016/j.surg.2015.10.025 .
doi: 10.1016/j.surg.2015.10.025
pubmed: 26652859
Massarweh NN, El-Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control J Moffitt Cancer Cent. 2017;24. https://doi.org/10.1177/1073274817729245 .
doi: 10.1177/1073274817729245
Hill JS, McPhee JT, Messina LM, Ciocca RG, Eslami MH. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era. J Vasc Surg. 2008;48:29–36.e1. https://doi.org/10.1016/j.jvs.2008.02.048 .
doi: 10.1016/j.jvs.2008.02.048
Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference? A follow-up analysis of another decade. Ann Surg. 2009;250:472–83. https://doi.org/10.1097/sla.0b013e3181b47c79 .
doi: 10.1097/SLA.0b013e3181b47c79
pubmed: 19730178
Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Montie JE, Wei JT. The regionalization of radical cystectomy to specific medical centers. J Urol. 2005;174(4 Pt 1):1385–9; discussion 1389.
doi: 10.1097/01.ju.0000173632.58991.a7
Miura JT, Johnston FM, Tsai S, et al. Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis. HPB. 2015;17:896–901. https://doi.org/10.1111/hpb.12446 .
doi: 10.1111/hpb.12446
pubmed: 26228076
pmcid: 4571757
Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS ONE. 2014;9:e84484. https://doi.org/10.1371/journal.pone.0084484 .
doi: 10.1371/journal.pone.0084484
pubmed: 24404166
pmcid: 3880302