Therapeutic Delays Lead to Worse Survival Among Patients With Hepatocellular Carcinoma

Abstract

Although prior studies have shown underuse of appropriate therapy in patients with hepatocellular carcinoma (HCC), no studies to date have assessed the prevalence and clinical impact of therapeutic delays among patients with HCC. The goal of this study was to characterize and identify factors associated with underuse and delays in treatment of these patients. A retrospective cohort study was conducted of patients with cirrhosis diagnosed with HCC at a large urban safety net hospital between January 2005 and June 2012. Dates for HCC diagnosis and any treatments were recorded. Univariate and multivariate analysis was used to determine factors associated with treatment underuse and delayed treatment, which was defined as time from diagnosis to treatment exceeding 3 months. The authors identified 267 treatment-eligible patients with HCC, of whom only 62% received HCC therapy. On multivariate analysis, tumor stage (odds ratio [OR], 0.48; 95% CI, 0.36–0.65), Child-Pugh class (OR, 0.49; 95% CI, 0.28–0.84), and black race (OR, 0.55; 95% CI, 0.31–0.99) were associated with lower rates of treatment use. The median time to treatment was 1.7 months, with 31% of patients experiencing delayed treatment. Delayed treatment was associated with the presence of ascites (hazard ratio [HR], 2.8; 95% CI, 1.3–6.1) and current treatment with transarterial chemoembolization (HR, 4.8; 95% CI, 1.8–12.5). After adjusting for tumor stage and Child-Pugh class, treatment underuse (HR, 0.33; 95% CI, 0.24–0.46) and delayed treatment (HR, 0.50; 95% CI, 0.30–0.84) were both associated with significantly worse survival. Results showed that, in addition to one-third of patients not receiving HCC-directed therapy, another 30% experienced significant therapeutic delays, leading to worse survival.

Neoangiogenesis-related genes are hallmarks of fast-growing hepatocellular carcinomas and worst survival. Results from a prospective study

“…During the 6-week interval, patients did not undergo any specific treatment. This interval is much shorter than the average time to treatment after HCC diagnosis14 15 and therefore no ethical issues were raised by IRB. After the second CT, patients were treated according to international guidelines1 and were monitored every 3 months unless their clinical condition required more frequent monitoring.…”

Role functioning is associated with survival in patients with hepatocellular carcinoma

“…), as previously described [6, 23]. Age, gender, race/ethnicity, insurance status, marital status, and alcohol and smoking history were recorded.…”

“…Patients with preserved hepatic function, good performance status, and early stage HCC can undergo curative treatments with 5-year survival rates approaching 70 % [3]. Unfortunately, most HCC patients have 5-year survival rates below 18 % due to detection at late stages and underuse of curative treatment [4–6]. Nearly two-thirds of HCC are found at advanced stages due to poor sensitivity of surveillance tests and underuse of surveillance in at-risk individuals [7–10].…”

Analysis of DNA Methylation in Plasma for Monitoring Hepatocarcinogenesis

“…Delayed diagnosis was a fatal obstacle to timely and successful treatment, leading to the low survival rate of HCC patients (Singal et al, 2013). Therefore, early diagnosis of HCC is particularly important.…”