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Published on: September 30, 2021
Hepatocellular carcinoma: Impact of academic setting and hospital volume on patient survival
Johannes Uhlig1, Cortlandt M Sellers2, Sajid A Khan3
1Section 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.
Insights
Hepatocellular carcinoma (HCC) patients treated at high-volume academic centers, particularly those with access to liver transplant, show improved survival. These findings highlight the importance of center type and volume in HCC patient outcomes.
Area of Science:
- Oncology
- Health Services Research
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Treatment strategies and outcomes for HCC can vary based on healthcare setting and hospital characteristics.
Purpose of the Study:
- To evaluate the influence of academic versus non-academic settings and hospital volume on overall survival for patients with hepatocellular carcinoma (HCC).
Main Methods:
- A retrospective analysis of the 2004-2015 National Cancer Database (NCDB) was conducted for HCC patients.
- First-line treatments included liver transplant, surgical resection, interventional oncology (IO), and chemotherapy.
- Patients were stratified by hospital volume (high vs. low) and academic affiliation.
Main Results:
- Over 63,000 HCC patients were analyzed across 1261 hospital systems.
- Treatment at academic centers and high-volume hospitals was associated with significantly superior overall survival compared to non-academic and low-volume centers, respectively (HR < 1, p < 0.001).
- These survival benefits were observed across all treatment modalities and varied by patient demographics and geographic location.
Conclusions:
- Academic centers exhibit distinct patterns in HCC treatment based on patient demographics and US geography.
- High-volume academic centers are associated with the longest patient survival in hepatocellular carcinoma care.
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.
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