Hospital Volume and Survival After Hepatocellular Carcinoma Diagnosis

Mokdad, Ali A.; Zhu, Hong; Marrero, Jorge A.; Mansour, John C.; Singal, Amit G.; Yopp, Adam C.

doi:10.1038/ajg.2016.181

Cited by 41 publications

(30 citation statements)

References 36 publications

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“…15 In addition, accredited programs are required to report to national cancer registries facilitating large-scale data analysis, which in turn promote improvements in institutional performance and quality of care. 16 16 …”

Section: Hospital Factorsmentioning

confidence: 99%

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Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma

Hester

Karbhari

Rich

et al. 2019

Cancer

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BACKGROUND: Fragmented cancer care (FC), or care received from multiple institutions, increases systemic health care costs and potentiates cancer care disparities. There is a paucity of data on mechanisms contributing to FC and the resulting effect on patient outcomes. This study characterized patient-and hospital-level factors associated with FC, time to treatment (TTT), and overall survival (OS) in patients with hepatocellular carcinoma (HCC). METHODS: Patients newly diagnosed with HCC from 2004 to 2015 and receiving treatment were identified in the Texas Cancer Registry. Patient-and hospital-level factors were compared across 2 cohorts: an FC treatment group and a nonfragmented cancer care (NFC) treatment group. Covariate-adjusted treatment use and OS were compared between the 2 treatment groups. RESULTS: Among 4329 patients with HCC, 1185 (27.4%) received FC, and 3144 (72.6%) received NFC. Compared with NFC patients, FC patients had larger tumors (median size ≥4 cm, 52.6% vs 35.2%; P < .001), and a higher proportion had a regional/metastatic stage (35.9% vs 26.7%; P < .001). Among patients with localized disease, FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95% confidence interval [CI], 0.7-0.9). FC was associated with worse OS (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24) and increased TTT (HR, 0.76; 95% CI, 0.7-0.8). In the subset of patients with localized-stage HCC who received curative therapy, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95% CI, 1.0-1.4) and increased TTT (HR, 0.74; 95% CI, 0.7-0.8). CONCLUSIONS: FC patients were less likely to undergo curative therapy when they were diagnosed at an early stage. After covariate adjustment, newly diagnosed patients with HCC receiving FC had worse OS and increased TTT. Cancer 2019;125:3428-3436.

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Section: Hospital Factorsmentioning

confidence: 99%

“…15 We stratified the hospital volume as described in prior studies, with high-volume HCC centers defined as having more than 24 annual individual HCC patient encounters. 16…”

Section: Hospital Factorsmentioning

confidence: 99%

Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma

Hester

Karbhari

Rich

et al. 2019

Cancer

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“…Hospital volumes have been measured according to various definitions, including the number of patients who were diagnosed, received treatment or underwent surgeries . Surgical procedure volume is a commonly used measurement to assess the volume‐outcome relationship .…”

Section: Introductionmentioning

confidence: 99%

“…3,4 A potential mechanism of the volume-outcome relationship is that hospitals with greater case volumes are likely to be equipped with skilled resources and advanced medical infrastructure, thereby providing optimal treatment and care; consequently, their patients obtain better treatment outcomes. 5 Hospital volumes have been measured according to various definitions, including the number of patients who were diagnosed, received treatment [5][6][7][8] or underwent surgeries. 4 Surgical procedure volume is a commonly used measurement to assess the volumeoutcome relationship.…”

mentioning

confidence: 99%

Hospital volume and postoperative 5‐year survival for five different cancer sites: A population‐based study in Japan

et al. 2020

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The relationship between hospital volume and patient outcome is globally known; thus, hospital volume is widely used as a quality indicator. In Japan, however, recent studies on this topic are scarce. The present study examined whether hospital surgery volume is associated with postoperative 5‐year survival among cancer patients. Using the Osaka Cancer Registry, we identified a sample of 86 145 patients who were diagnosed with cancer at any of five different sites (stomach, colorectum, lung, breast and uterus) and underwent surgeries between 2007 and 2011 in Osaka. We ranked hospitals by annual surgical volume, sorted patients in descending order by hospital volume, and assigned them into quartiles (high, medium, low and very low volume). We analyzed the association between hospital volume and 5‐year survival among 80 959 patients aged between 15 and 84 years using Cox proportional hazard models. Adjustments were made for characteristics of patients, type of surgery and adjuvant treatment received. The mortality hazard of patients treated at very low‐volume hospitals was 1.36‐1.82‐fold higher than that of patients treated at high‐volume hospitals. Absolute differences in adjusted survival rates between high‐volume and very low‐volume hospitals varied with the cancer site: 14.9 in stomach, 11.5 in colorectal, 10.8 in lung, 2.4 in breast and 3.3 in uterine cancers. Hospitals with lower surgery volumes showed higher mortality risks after cancer surgery than those with higher volumes. Monitoring site‐specific surgery volumes and referring patients from low‐volume to high‐volume hospitals may be beneficial for improving the long‐term survival of cancer patients.

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“…HCC is a heterogeneous disease originated from chronic liver diseases, such as chronic inflammation and cirrhosis. To date, the therapeutic strategy against HCC is mainly composed of resection, transplantation, local ablation, and chemotherapy (3,4). Because early symptoms of HCC are not obvious, most patients with HCC are diagnosed at advanced stages and are unsuitable for potentially curative therapies such as resection, transplantation, and local ablation (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Lycorine Promotes Autophagy and Apoptosis via TCRP1/Akt/mTOR Axis Inactivation in Human Hepatocellular Carcinoma

Qiu

Pang

et al. 2017

Molecular Cancer Therapeutics

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Lycorine is a multifunctional bioactive compound, and it possesses potential anticancer activities. However, little is known about the underlying mechanism. In this research, we have found that lycorine significantly induces the apoptotic and autophagic capacities of hepatocellular carcinoma (HCC) cells in vitro and in vivo. Treatment with specific autophagy inhibitor (3-methyladenine/Bafilomycin A1) or knockdown of LC-3B/Atg5 by siRNA drastically enhances the apoptotic cell death effect by facilitating the switch from autophagy to apoptosis. Molecular validation mechanistically demonstrates that lycorine-induced apoptosis and autophagy in HCC cells is associated with decreased protein levels of tongue cancer resistance-associated protein 1 (TCRP1), and we further find that inhibition of TCRP1 decreases phosphorylation level of Akt and represses Akt/mTOR signaling. Finally, lycorineinduced apoptosis and autophagy suppress the growth of xenograft hepatocellular tumors without remarkable toxicity. Our results elucidate a novel molecular mechanism whereby lycorine promotes apoptosis and autophagy through the TCRP1/Akt/mTOR pathway in HCC. Our results reveal that lycorine might be a potential therapeutic agent for the treatment of HCC.

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Hospital Volume and Survival After Hepatocellular Carcinoma Diagnosis

Abstract: Hospital volume is associated with improved overall survival, particularly in localized HCC. Improved survival may be mediated by increased utilization of treatments in high HCC volume hospitals.

Cited by 41 publications

References 36 publications

Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma

Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma

Hospital volume and postoperative 5‐year survival for five different cancer sites: A population‐based study in Japan

Lycorine Promotes Autophagy and Apoptosis via TCRP1/Akt/mTOR Axis Inactivation in Human Hepatocellular Carcinoma

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