Evaluating the Impact of Multi-Institutional Care in Early-Stage Hepatocellular Carcinoma: A Nationwide Analysis

Oncologic care received at more than one institution has been shown to negatively impact patient survival in gastric and rectal cancers. Our study evaluated the effect of multi-institutional care (MC) on time to treatment initiation (TTI) and survival in early-stage HCC.

The National Cancer Database was queried for patients with Stage I and II HCC (2004-2020). Patients were categorized as single-institution care (SC) or multi-institutional care (MC). A negative binomial regression model was used to identify predictors of increased TTI. Survival analyses were estimated with the Kaplan-Meier method.

Of 12,704 patients, 51% (n = 6471) received MC and 49% (n = 6233) SC. MC patients were more often older (p < 0.0001), White (p < 0.0001), privately insured (p < 0.0001), and traveling greater distances (p = 0.0001). Median TTI was longer for MC patients than SC (61 vs. 50 days; p < 0.0001). Black, underinsured (Medicaid/other government insurance), and MC patients were associated with increased TTI by factors of 1.131 (95% CI: 1.093-1.170; p < 0.0001), 1.081 (95% CI: 1.046-1.119; p < 0.0001), and 1.203 (95% CI: 1.176-1.231; p < 0.0001). Survival was similar between MC and SC at 1 year (p = 0.1514) and 5 years (p = 0.1769).

Despite increased treatment time, there was no appreciable survival disadvantage among patients receiving care at multiple sites.