BACKGROUND The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. METHODS A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. RESULTS Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; p < 0.001), Child-Pugh A (94% vs. 83% vs. 80%; p = 0.022), and hepatitis B (37% vs. 15% vs. 4%; p < 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; p = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; p = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; p < 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503-0.844; p = 0.001). CONCLUSIONS Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival.

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地理对肝细胞癌的影响：一项基于人群的回顾性研究

背景 肝细胞癌 (HCC) 的治疗包括不同的治疗方式和多学科肿瘤委员会审查。地理和治疗中心类型（四级与非四级）对获得护理的影响尚不清楚。方法 对 2008 年至 2016 年不列颠哥伦比亚省接受索拉非尼治疗的 HCC 患者进行回顾性图表审查。患者按加拿大统计局人口中心 (PC) 大小标准分组：大型 PC (LPC)、中型 PC (MPC) 和小型 PC (SPC)。比较了各组对专家的接触、肝脏定向治疗的接受情况和生存结果。结果 286 例患者的地理分布为： LPC：75%；MPC：16%；和 SPC：9%。更高比例的亚洲人（51% vs. 9% vs. 4%；p < 0.001），Child-Pugh A（94% vs. 83% vs. 80%；p = 0.022），分别在 LPC 与 MPC 与 SPC 中观察到乙型肝炎（37% 与 15% 与 4%；p < 0.001）。LPC 患者更有可能转诊至肝病专家（62% 与 48% 与 40%；p = 0.031）并接受经动脉化疗栓塞 (TACE)（43% 与 24% 与 24%；p = 0.018）。60% 在四级中心接受治疗，在四级中心接受治疗的患者的中位总生存期 (OS) 高于非四级中心（分别为 28.0 个月和 14.6 个月；p < 0.001），但与 PC 相比相似尺寸。在四元中心的治疗预测多变量分析的生存率提高（风险比 (HR)：0.652；95% 置信区间 (CI)：0.503-0.844；p = 0.001）。结论 地理似乎不影响 OS，但 LPC 患者更有可能被转诊至肝病学并接受 TACE。