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• W3045011025 abstract "Presenter: Sarah Bateni MD | University of California, Davis Background: In California, access to healthcare and specialty services such as liver transplantation varies by geographic location. Evaluation of geographic disparities on patient outcomes is limited. We examine regional differences in treatment and survival among early stage hepatocellular carcinoma (HCC) patients treated in California. We hypothesize that patients from regions without transplant and fewer National Cancer Institute (NCI) designated cancer centers would less frequently undergo resection and transplantation resulting in worse overall survival (OS). Methods: A retrospective analysis of individuals diagnosed from 2005 to 2017 with stage I & II HCC in the California Cancer Registry was performed. Surgical treatment was categorized into four groups: none, ablation, resection, and transplantation. Four California regions were identified: greater Sacramento region (Sacramento), northern bay area (Bay), southern coast (South), and north/central California (North/Central). Multivariable logistic and Cox proportional hazards regression analyses were performed to compare clinicopathologic and geographic differences in treatment and OS. Results: Of the 19,555 patients with stage I-II HCC, 43.0% were treated in the South, 24.6% were treated in the Bay, 21.5% were treated in the North/Central, and 10.9% were treated in Sacramento. Most patients (64.1%) had no surgical intervention, while 16.6% underwent ablation, 12.9% underwent resection, and 6.4% underwent transplant. There were significant disparities in treatment and survival based on geographic region in both univariate and multivariable analyses when controlling for demographic and clinicopathologic factors. Sacramento patients were less likely to undergo resection (OR 0.64, 95%CI 0.51-0.79, p<0.001) and more likely to undergo ablation (OR 1.64, 95%CI 1.42-1.90, p<0.001) compared to Bay patients. South patients were more likely to undergo ablation (OR 1.51, 95%CI 1.36-1.68, p<0.001) compared to Bay patients. There were no significant differences in odds of transplantation based on geographic region (p>0.05 all). Public insurance, absence of insurance, and lower neighborhood socioeconomic status were associated with lower odds of any treatment (p<0.05 all), while NCI- designated cancer center status was associated with greater odds of all surgical treatments (p<0.001 all). Ablation (HR 1.69, 95%CI 1.56-1.84, p<0.001) and no treatment (HR 2.90, 95%CI 2.70-3.12, p<0.001) were associated with worse OS compared to resection, while transplantation was associated with better OS (HR 0.60, 95%CI 0.53-0.68, p<0.001). Sacramento (OR 1.14, 95%CI 1.07-1.22, p<0.001) and South (OR 1.08, 95%CI 1.03-1.14, p<0.001) regions were associated with worse OS compared to the Bay region. Conclusion: These findings suggest that significant geographic treatment disparities exist for early stage HCC in California. They highlight the need for targeted measures to address these disparities in care to patients in the greater Sacramento area and South." @default.
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• W3045011025 date "2020-01-01" @default.
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• W3045011025 title "Regional variation in the surgical treatment and survival of early stage hepatocellular carcinoma in California" @default.
• W3045011025 doi "https://doi.org/10.1016/j.hpb.2020.04.535" @default.
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