Hepatocellular carcinoma: Impact of academic setting and hospital volume on patient survival

Authors

Johannes Uhlig, Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany. Electronic address: johannes.uhlig@yale.edu.Follow
Cortlandt M. Sellers, Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA. Electronic address: cortlandt.sellers@yale.edu.Follow
Sajid A. Khan, Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA. Electronic address: sajid.khan@yale.edu.Follow
Charles Cha, Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA. Electronic address: charles.cha@yale.edu.Follow
Hyun S. Kim, Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA. Electronic address: kevin.kim@yale.edu.Follow

Document Type

Article

Publication Title

Surgical oncology

Abstract

BACKGROUND AND OBJECTIVES: To assess the impact of academic setting and hospital on overall survival in patient with hepatocellular carcinoma (HCC). METHODS: The 2004-2015 NCDB was queried for HCC. First line treatment was stratified as liver transplant, surgical resection, interventional oncology (IO) and chemotherapy. Hospital volume was stratified as high (ranking among top 10% in case numbers) and low volume. Overall survival was assessed via multivariable Cox regressions. RESULTS: 63,877 patients treated at 1261 hospital systems were included (transplant n = 10,596, surgical resection n = 11,132, IO n = 12,286, chemotherapy n = 29,863; academic centers n = 226, non-academic n = 1035). Younger African American patients with private insurance, high income and education were more likely treated at academic centers. US geographical discrepancies were evident, with highest academic center treatment rates in New England states (83.6%) and lowest in South Atlantic states (48.6%). Overall survival was superior for academic versus non-academic centers (HR = 0.89, 95% CI: 0.87-0.91, p < 0.001) and high versus low volume centers (HR = 0.79, 95% CI: 0.77-0.81, p < 0.001), after multivariable adjustment for potential confounders. These effects were evident among all HCC treatment modalities. CONCLUSIONS: HCC treatment in academic centers shows distinct patterns according to patient demographics and US geography. Longest patient survival is observed in high-volume academic centers.

First Page

111

Last Page

118

DOI

10.1016/j.suronc.2019.10.009

Publication Date

12-1-2019

Recommended Citation

Uhlig, Johannes; Sellers, Cortlandt M.; Khan, Sajid A.; Cha, Charles; and Kim, Hyun S., "Hepatocellular carcinoma: Impact of academic setting and hospital volume on patient survival" (2019). Surgery. 203.
https://scholar.bridgeporthospital.org/surgery/203

Identifier

31654956 (pubmed); 10.1016/j.suronc.2019.10.009 (doi); S0960-7404(19)30185-9 (pii)