Decision to operate on hepatocellular cancer patients is not driven by comorbidities in Louisiana

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2025-05-01 DOI:10.1016/j.hpb.2025.01.013

Annie Talbot , Denise Danos , Yong Yi , Lauren Maniscalco , Xiao-Cheng Wu , Omeed Moaven , Mary Maluccio , John Lyons III

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Abstract

Background

The mortality rate of Hepatocellular cancer (HCC) in Louisiana is second worst in the United States. This has been linked to underutilization of curative treatment (CT). This study aimed to identify risk factors associated with underutilization of CT in Louisiana.

Methods

Patients with AJCC T1 HCC diagnosed from 2011 to 2020 were identified from the Louisiana Tumor Registry (LTR) using site and histology codes. Patients who underwent CT (ablation, resection, and transplantation) were compared to those who did not undergo CT. Logistic regression was performed and results reported as adjusted odds ratios.

Results

CT was utilized in 462 (37 %) of 1247 patients with T1 HCC. There were no significant differences observed in age, race, BMI, poverty, or rurality between CT and non-CT patients. The percentage of cirrhosis was similar in both groups (35.3 % vs. 37.7 %, NS). On multivariant analysis, lack of CT was independently associated with low socioeconomic status (SES; p = 0.040), treatment outside a COC center (p < 0.001), and lack commercial/private insurance (p < 0.001).

Conclusion

Utilization of CT is driven not by comorbidities, but by insurance type, low SES, and treatment facility indicating the profound effect that care disparities have on HCC treatment.

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在路易斯安那州，决定对肝细胞癌患者进行手术并不是由合并症驱动的。

背景：路易斯安那州肝细胞癌（HCC）的死亡率在美国排名第二。这与治愈性治疗（CT）的利用不足有关。本研究旨在确定与路易斯安那州CT未充分利用相关的危险因素。方法：2011年至2020年诊断为AJCC T1 HCC的患者从路易斯安那州肿瘤登记处（LTR）使用部位和组织学代码进行鉴定。将接受CT（消融、切除和移植）的患者与未接受CT的患者进行比较。进行逻辑回归，并以调整后的优势比报告结果。结果：1247例T1期HCC患者中有462例（37%）采用CT检查。CT和非CT患者在年龄、种族、BMI、贫困或农村地区没有显著差异。两组的肝硬化比例相似（35.3% vs. 37.7%， NS）。在多变量分析中，缺乏CT与低社会经济地位(SES；p = 0.040)，在COC中心以外的治疗(p结论：CT的使用不是由合并症驱动的，而是由保险类型、低SES和治疗设施驱动的，这表明护理差异对HCC治疗有深远的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).