Pilot prognostic model of extremely poor survival among high-risk hepatocellular carcinoma patients

Populations with low income, economic barriers, and cultural and/or linguistic access barriers to medical care are at risk for worse cancer-related outcomes. Medically underserved patients with hepatocellular carcinoma (HCC) have decreased survival compared with those in the Surveillance, Epidemiology, and End Results database. Given this suboptimal outcome, the high cost of HCC treatment, and unknown risk-to-benefit ratios of invasive therapies, the authors sought to identify a predictive model of extremely poor overall survival (OS).

A retrospective review of an institutional HCC database was conducted. Payor status, race, treatment, clinicopathologic, and outcome parameters were recorded. The primary outcome was OS <1 month. A logistic regression model predictive of OS <1 month was developed using backward, stepwise elimination and bootstrapping techniques.

In total, 337 patients HCC (272 men and 65 women) were identified. Only 4% of patients had Medicare coverage; whereas 96% relied on publicly funded, safety-net health programs. OS <1 month was noted in 90 patients (26.7%). There were no differences in race or sex between patients who had an OS <1 month and those with an OS >1 month. A higher percentage of patients who had an OS <1 month had advanced stage disease and did not receive therapy for HCC. Advanced liver disease, as measured by laboratory parameters and a composite score (Child-Pugh and Model for End-Stage Liver Disease [MELD]), alpha fetoprotein level, creatinine level, disease stage, and lack of treatment were predictors of OS <1 month.

Survival for medically underserved patients with HCC remains poor. Advanced clinical stage and liver disease appear to preclude treatment, and novel methods to identify those who may benefit from palliative care/symptom control may be indicated for patients who are predicted to have poor survival.