Background & Aims

Failures have been reported across the cancer care continuum in patients with hepatocellular carcinoma (HCC); however, the impact of treatment delays on outcomes has not been well-characterized. We described the prevalence of treatment delays in a racially and ethnically diverse cohort of patients and its association with overall survival.

Methods

Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients diagnosed with HCC between 2001 and 2015. We performed multivariable logistic regression analysis to identify factors associated with treatment delay (ie, receipt of HCC-directed therapy >3 months after diagnosis). Cox proportional hazards regression analysis with a 5-month landmark was used to characterize the association between treatment delay and overall survival, accounting for immortal time bias.

Results

Of 8450 patients with treatment within 12 months of HCC diagnosis, 1205 (14.3%) experienced treatment delays. The proportion with treatment delays ranged from 6.8% of patients undergoing surgical resection to 21.6% of those undergoing liver transplantation. In multivariable analysis, Black patients (odds ratio, 1.96; 95% confidence interval [CI], 1.21–3.15) and those living in high poverty neighborhoods (odds ratio, 1.55; 95% CI, 1.25–1.92) were more likely to experience treatment delays than white patients and those living in low poverty neighborhoods, respectively. Treatment delay was independently associated with worse survival (hazard ratio 1.15, 95% CI, 1.05–1.25).

Conclusions

Nearly 1 in 7 patients with HCC experience treatment delays, with higher odds in Black patients and those living in high poverty neighborhoods. Treatment delays are associated with worse survival, highlighting a need for interventions to improve time-to-treatment.

中文翻译：

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美国肝细胞癌患者治疗延迟的种族、民族和社会经济差异

背景与目标

在肝细胞癌 (HCC) 患者的整个癌症治疗过程中均有失败的报道；然而，治疗延误对结果的影响尚未得到很好的表征。我们描述了种族和民族不同的患者队列中治疗延迟的普遍性及其与总生存期的关系。

方法

使用监测、流行病学和最终结果-Medicare 数据库，我们确定了 2001 年至 2015 年间诊断为 HCC 的患者。我们进行了多变量逻辑回归分析以确定与治疗延迟相关的因素（即，在接受 HCC 导向治疗后 >3 个月）诊断）。以 5 个月为界标的 Cox 比例风险回归分析用于描述治疗延迟与总生存期之间的关联，解释了不朽的时间偏差。

结果

在 HCC 诊断后 12 个月内接受治疗的 8450 名患者中，1205 名 (14.3%) 经历了治疗延误。延迟治疗的比例从接受手术切除的患者的 6.8% 到接受肝移植的患者的 21.6% 不等。在多变量分析中，黑人患者（比值比，1.96；95% 置信区间 [CI]，1.21-3.15）和生活在高贫困社区的患者（比值比，1.55；95% CI，1.25-1.92）更有可能经历分别比白人患者和生活在低贫困社区的患者延迟治疗。治疗延迟与较差的生存率独立相关（风险比 1.15，95% CI，1.05–1.25）。

结论

近七分之一的 HCC 患者经历治疗延误，黑人患者和生活在高贫困社区的人的几率更高。治疗延误与较差的生存率相关，突出表明需要采取干预措施来缩短治疗时间。