Centers with more therapeutic modalities are associated with improved outcomes for patients with hepatocellular carcinoma

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Abstract

Background: Higher facility volume is correlated to better overall survival (OS), but there is little knowledge on the effect of facility treatment modality number on OS in hepatocellular carcinoma (HCC). Methods: This is a retrospective analysis of data from the National Cancer Database (NCDB) from 2004-2014 on patients with non-metastatic HCC. Treatment modalities assessed were surgical resection, transplantation, ablation, radioembolization, stereotactic body radiation therapy (SBRT), single-agent chemotherapy, and multi-agent chemotherapy. Facilities were dichotomized at the median of the listed treatment modalities. Results: There were a total of 112,512 patients with non-metastatic HCC. Of a total of 1,230 sites, 830 (67.5%) used four or fewer modalities. Average survival for patients treated at facilities using fewer modalities was 12.0 and 23.5 months for those treated at facilities with more modalities [hazard ratio (HR) =0.52, 95% confidence interval (CI): 0.51-0.53, P<0.001]. After adjusting for facility volume, liver function, tumor and patient characteristics and other prognostic factors in a multivariable Cox model, treatment at a multi-modality facility still provided a survival advantage (HR =0.60, 95% CI: 0.52-0.70, P<0.001). This benefit also persisted after propensity score matching. Sensitivity analysis varying the cut point from 2 to 6 modalities for dichotomization showed that the benefit persisted. Subgroup stratified analyses based on stage showed that the benefit in OS was highest for patients with stage I and II (P≤0.002) but was not significant for stage III or IVa. Conclusions: Institutions that offered more treatment modalities had improved OS for patients with non-metastatic HCC, especially for those with stage I and II.

Original languageEnglish (US)
Pages (from-to)546-553
Number of pages8
JournalJournal of Gastrointestinal Oncology
Volume10
Issue number3
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hepatocellular Carcinoma
Survival
Therapeutics
Confidence Intervals
Drug Therapy
Propensity Score
Proportional Hazards Models
Neoplasms
Radiotherapy
Transplantation
Databases
Liver

Keywords

  • Hepatocellular carcinoma (HCC)
  • National Cancer Database (NCDB)
  • Number of treatment modalities
  • Stereotactic body radiation therapy (SBRT)

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

@article{86e15fdfec1945bd8b9eac22c8457783,
title = "Centers with more therapeutic modalities are associated with improved outcomes for patients with hepatocellular carcinoma",
abstract = "Background: Higher facility volume is correlated to better overall survival (OS), but there is little knowledge on the effect of facility treatment modality number on OS in hepatocellular carcinoma (HCC). Methods: This is a retrospective analysis of data from the National Cancer Database (NCDB) from 2004-2014 on patients with non-metastatic HCC. Treatment modalities assessed were surgical resection, transplantation, ablation, radioembolization, stereotactic body radiation therapy (SBRT), single-agent chemotherapy, and multi-agent chemotherapy. Facilities were dichotomized at the median of the listed treatment modalities. Results: There were a total of 112,512 patients with non-metastatic HCC. Of a total of 1,230 sites, 830 (67.5{\%}) used four or fewer modalities. Average survival for patients treated at facilities using fewer modalities was 12.0 and 23.5 months for those treated at facilities with more modalities [hazard ratio (HR) =0.52, 95{\%} confidence interval (CI): 0.51-0.53, P<0.001]. After adjusting for facility volume, liver function, tumor and patient characteristics and other prognostic factors in a multivariable Cox model, treatment at a multi-modality facility still provided a survival advantage (HR =0.60, 95{\%} CI: 0.52-0.70, P<0.001). This benefit also persisted after propensity score matching. Sensitivity analysis varying the cut point from 2 to 6 modalities for dichotomization showed that the benefit persisted. Subgroup stratified analyses based on stage showed that the benefit in OS was highest for patients with stage I and II (P≤0.002) but was not significant for stage III or IVa. Conclusions: Institutions that offered more treatment modalities had improved OS for patients with non-metastatic HCC, especially for those with stage I and II.",
keywords = "Hepatocellular carcinoma (HCC), National Cancer Database (NCDB), Number of treatment modalities, Stereotactic body radiation therapy (SBRT)",
author = "Jiang, {Julie M.} and Nitin Ohri and Justin Tang and Moadel, {Renee M.} and Jacob Cynamon and Andreas Kaubisch and Milan Kinkhabwala and Garg, {Madhur K.} and Chandan Guha and Rafi Kabarriti",
year = "2019",
month = "1",
day = "1",
doi = "10.21037/jgo.2019.01.30",
language = "English (US)",
volume = "10",
pages = "546--553",
journal = "Journal of Gastrointestinal Oncology",
issn = "2078-6891",
publisher = "Pioneer Bioscience Publishing Company (PBPC)",
number = "3",

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TY - JOUR

T1 - Centers with more therapeutic modalities are associated with improved outcomes for patients with hepatocellular carcinoma

AU - Jiang, Julie M.

AU - Ohri, Nitin

AU - Tang, Justin

AU - Moadel, Renee M.

AU - Cynamon, Jacob

AU - Kaubisch, Andreas

AU - Kinkhabwala, Milan

AU - Garg, Madhur K.

AU - Guha, Chandan

AU - Kabarriti, Rafi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Higher facility volume is correlated to better overall survival (OS), but there is little knowledge on the effect of facility treatment modality number on OS in hepatocellular carcinoma (HCC). Methods: This is a retrospective analysis of data from the National Cancer Database (NCDB) from 2004-2014 on patients with non-metastatic HCC. Treatment modalities assessed were surgical resection, transplantation, ablation, radioembolization, stereotactic body radiation therapy (SBRT), single-agent chemotherapy, and multi-agent chemotherapy. Facilities were dichotomized at the median of the listed treatment modalities. Results: There were a total of 112,512 patients with non-metastatic HCC. Of a total of 1,230 sites, 830 (67.5%) used four or fewer modalities. Average survival for patients treated at facilities using fewer modalities was 12.0 and 23.5 months for those treated at facilities with more modalities [hazard ratio (HR) =0.52, 95% confidence interval (CI): 0.51-0.53, P<0.001]. After adjusting for facility volume, liver function, tumor and patient characteristics and other prognostic factors in a multivariable Cox model, treatment at a multi-modality facility still provided a survival advantage (HR =0.60, 95% CI: 0.52-0.70, P<0.001). This benefit also persisted after propensity score matching. Sensitivity analysis varying the cut point from 2 to 6 modalities for dichotomization showed that the benefit persisted. Subgroup stratified analyses based on stage showed that the benefit in OS was highest for patients with stage I and II (P≤0.002) but was not significant for stage III or IVa. Conclusions: Institutions that offered more treatment modalities had improved OS for patients with non-metastatic HCC, especially for those with stage I and II.

AB - Background: Higher facility volume is correlated to better overall survival (OS), but there is little knowledge on the effect of facility treatment modality number on OS in hepatocellular carcinoma (HCC). Methods: This is a retrospective analysis of data from the National Cancer Database (NCDB) from 2004-2014 on patients with non-metastatic HCC. Treatment modalities assessed were surgical resection, transplantation, ablation, radioembolization, stereotactic body radiation therapy (SBRT), single-agent chemotherapy, and multi-agent chemotherapy. Facilities were dichotomized at the median of the listed treatment modalities. Results: There were a total of 112,512 patients with non-metastatic HCC. Of a total of 1,230 sites, 830 (67.5%) used four or fewer modalities. Average survival for patients treated at facilities using fewer modalities was 12.0 and 23.5 months for those treated at facilities with more modalities [hazard ratio (HR) =0.52, 95% confidence interval (CI): 0.51-0.53, P<0.001]. After adjusting for facility volume, liver function, tumor and patient characteristics and other prognostic factors in a multivariable Cox model, treatment at a multi-modality facility still provided a survival advantage (HR =0.60, 95% CI: 0.52-0.70, P<0.001). This benefit also persisted after propensity score matching. Sensitivity analysis varying the cut point from 2 to 6 modalities for dichotomization showed that the benefit persisted. Subgroup stratified analyses based on stage showed that the benefit in OS was highest for patients with stage I and II (P≤0.002) but was not significant for stage III or IVa. Conclusions: Institutions that offered more treatment modalities had improved OS for patients with non-metastatic HCC, especially for those with stage I and II.

KW - Hepatocellular carcinoma (HCC)

KW - National Cancer Database (NCDB)

KW - Number of treatment modalities

KW - Stereotactic body radiation therapy (SBRT)

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DO - 10.21037/jgo.2019.01.30

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