A Population-Based Analysis of Care and Outcomes for Hepatocellular Carcinoma

基于人群的肝细胞癌护理和结果分析

• 批准号: 7541665
• 负责人: Nader Nabile Massarweh
• 金额: $ 5.47万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7541665
• 关键词: Ablation; Adoption; Caring; Characteristics; Clinical; Clinical Trials; Cohort Studies; Communities; Data; Diagnosis; Disease; Disease regression; Early treatment; Environment; Epidemic; Excision; Future; Geographic Locations; Goals; Hepatic; Hepatitis C; Hospitals; Incidence; Intervention; Invasive; Link; Liver neoplasms; Logistic Regressions; Malignant Neoplasms; Medicare; Morbidity - disease rate; Numbers; Operative Surgical Procedures; Organ; Outcome; Outpatients; Patients; Personal Satisfaction; Physicians; Platelet Factor 4; Population; Primary carcinoma of the liver cells; Procedures; Provider; Radiation; Radiofrequency Interstitial Ablation; Rate; Relative (related person); Research; Resources; Role; Safety; Solid; Staging; Standards of Weights and Measures; Surgeon; Surgical Management; Survival Rate; Techniques; Testing; Time; Tissues; Training; Transplantation; Uncertainty; United States; Variant; Work; base; cancer care; chemotherapy; cohort; day; improved; interest; liver transplantation; mortality; neoplasm registry; new technology; prospective; radiologist; socioeconomics; trend; tumor

DESCRIPTION (provided by applicant): Hepatocellular carcinoma (HCC) is the most common solid organ tumor and one of the most frequently encountered malignancies in the world. Likely a result of the hepatitis C epidemic of the 1970's and 1980's, the incidence of this cancer has doubled in the United States during the past decade and worldwide approximately 1 million new cases are diagnosed per year. Traditionally, curative therapy for early-stage HCC has been surgical. However, radiofrequency ablation (RFA) has recently gained popularity in the treatment of HCC. RFA offers a number of potential advantages over surgical therapy. It can be applied through a minimally invasive approach, may be performed as an outpatient procedure, allows treatment of HCC in care environments that do not have the resources to perform surgical resection or transplantation, and allows non-surgical practitioners (such as interventional radiologists) the opportunity to treat patients with HCC. RFA successfully ablates tissue, but its efficacy as a primary, curative treatment for HCC has not been well tested. How the community at large utilizes RFA is also unknown. Recent data suggests RFA is becoming a primary treatment option for early stage HCC without quality evidence to support this practice. The proposed research intends to use a large, population-based cancer registry (SEER) as well as linked Medicare claims data (SEER-Medicare) to better define how HCC is treated in the community at large, to detect trends in the use of RFA, and evaluate outcomes associated with HCC care. Using a cohort of patients diagnosed with HCC between 1992 and 2005, we plan to 1.) describe stage-specific temporal trends in RFA use; 2.) characterize regional variation and patient- and physician/hospital-level factors associated with the use of RFA; 3.) describe differences in 30-day mortality between patients who received RFA and those who underwent surgical therapy after adjusting for relevant factors; 4.) describe differences in overall and cause-specific survival among patients with early-stage HCC who received RFA and those who underwent surgical therapy after adjusting for relevant factors. Logistic regression will be used to examine trends in RFA use over time and to evaluate potential predictors of RFA use. Logistic regression will also be used to explore the relationship between RFA use and early mortality while adjusting for stage as well as patient and provider factors. Cox multivariate regression will be used to explore the relationship between RFA use and long-term survival while adjusting for stage as well as patient and provider factors. This work has implications for improving the quality of surgical care and these findings will help to inform future, prospective clinical trials aimed at clarifying the role for RFA in the treatment of HCC

描述（由申请人提供）：肝细胞癌（HCC）是最常见的实体器官肿瘤，也是世界上最常见的恶性肿瘤之一。可能是1970年代和1980年代的丙型肝炎流行的结果，在过去的十年中，这种癌症的发病率增加了一倍，每年诊断出大约100万例新病例。传统上，早期HCC的治疗疗法是手术。然而，射频消融（RFA）最近在HCC的治疗方面越来越受欢迎。 RFA在手术疗法上具有许多潜在的优势。它可以通过微创方法应用，可以作为门诊手术，允许在没有资源进行手术切除或移植资源的护理环境中治疗HCC，并允许非手术从业者（例如干预放射学家）治疗HCC患者的机会。 RFA成功地消融了组织，但其作为基本治疗性HCC的疗效尚未得到很好的测试。整个社区如何利用RFA也是未知的。最近的数据表明，RFA正在成为早期HCC的主要治疗选择，而没有质量证据来支持这种做法。拟议的研究旨在使用大型的，基于人群的癌症注册表（SEER），以及将Medicare索赔数据（SEER-MEDICARE）联系起来，以更好地定义整个社区中如何处理HCC，以检测RFA使用的趋势，并评估与HCC Care相关的结果。使用1992年至2005年间诊断为HCC的一组患者，我们计划1.）描述RFA使用中特定于阶段的时间趋势； 2.）表征与使用RFA相关的区域变异以及患者和医师/医院/医院水平的因素； 3.）描述接受RFA的患者与接受相关因素后接受手术治疗的患者的30天死亡率差异； 4.）描述接受RFA的早期HCC患者以及在调整相关因素后接受手术疗法的患者的总体和原因特定生存率的差异。逻辑回归将用于检查RFA随着时间的使用趋势，并评估RFA使用的潜在预测指标。逻辑回归还将用于探索RFA使用与早期死亡率之间的关系，同时调整阶段以及患者和提供者的因素。 COX多元回归将用于探索RFA使用与长期生存之间的关系，同时调整阶段以及患者和提供者的因素。这项工作对提高手术护理的质量具有影响，这些发现将有助于为未来的前瞻性临床试验提供信息，旨在阐明RFA在治疗HCC中的作用。