Guideline-based surveillance and treatment of hepatocellular carcinoma

基于指南的肝细胞癌监测和治疗

• 批准号: 8324500
• 负责人: Jessica A Davila
• 金额: $ 32.47万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-25 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8324500
• 关键词: Abdomen; Ablation; Accounting; Address; Adherence; American; Cancer Etiology; Categories; Cessation of life; Chronic Hepatitis B; Cirrhosis; Clinical Practice Guideline; Cohort Studies; Comorbidity; Computerized Medical Record; Data; Development; Diagnosis; Disease; Early Diagnosis; Early treatment; Effectiveness; Etiology; Excision; Financial compensation; Foundations; Future; Guidelines; Healthcare; Healthcare Systems; Hepatitis B; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Image; Incidence; Intervention; Liver; Liver diseases; Logistic Regressions; Malignant Neoplasms; Medicare; Outcome; Patients; Pensions; Physicians; Practice Guidelines; Primary carcinoma of the liver cells; Provider; Publishing; Recommendation; Reporting; Resources; Retrospective Studies; Risk Factors; Role; Sampling; Serum; Stage at Diagnosis; Staging; Structural Models; Structure; Survival Rate; Testing; Transplantation; Ultrasonography; United States; Update; Veterans; abstracting; administrative database; advanced disease; alpha-Fetoproteins; base; clinical practice; effective therapy; experience; high risk; improved; interest; medical specialties; mortality; non-alcoholic fatty liver; preference; therapy development; wasting

DESCRIPTION (provided by applicant): Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related deaths. Survival following diagnosis with HCC is poor unless it is detected early and stage-appropriate treatment is applied. Clinical practice guidelines outline recommendations for HCC surveillance and treatment of HCC. No study has examined the implementation or outcomes of guideline-based HCC surveillance in high risk patients or stage- appropriate treatment in patients who develop HCC. OBJECTIVES: Using data obtained from VA administrative databases combined with information abstracted from national VA electronic medical records using the VA Compensation and Pension Record Interchange application, we propose to address the following Aims: 1) to examine the implementation of guideline-based HCC surveillance in a national sample of patients with cirrhosis, and to examine patient, physician and facility factors associated with appropriate or inappropriate implementation of surveillance; 2) to evaluate the implementation of guideline-based stage-appropriate treatment among patients with HCC, and to examine patient, physician, and facility factors associated with receipt of stage-appropriate treatment; and 3) to examine the effect of guideline-based HCC surveillance and stage-appropriate treatment on survival. METHODS: We propose a retrospective cohort study using two stratified random samples of approximately 1,500 patients with cirrhosis and 1,500 patients with HCC diagnosed during 2006-2009 in VA facilities nationwide. For Aim 1, the outcome will be appropriate (guideline-based surveillance, receipt of an imaging test unrelated to HCC surveillance, no surveillance) versus inappropriate (non-guideline based surveillance, overutilization of surveillance) implementation of HCC surveillance among patients with one of the four primary etiologies for cirrhosis (hepatitis C, non-alcoholic fatty liver disease, hepatitis B, alcoholic liver disease). Patient, physician, and facility factors associated with appropriate implementation of HCC surveillance will be examined using logistic regression. For Aim 2, the outcome will be receipt of stage-appropriate HCC treatment versus stage-inappropriate treatment or no treatment among patients with HCC. Each patient will be assigned to a stage-appropriate treatment category according to current guidelines, which will be compared against the treatment received. Logistic regression will be used to examine predictors of receiving stage-appropriate treatment. For Aim 3, the outcome will be survival among patients with cirrhosis who developed HCC. Receipt of appropriate HCC surveillance and stage-appropriate treatment will be the primary predictors of interest. Marginal structural modeling will be used to examine these associations. IMPACT: This study will examine an important and timely issue in the management of HCC that has not been examined. Findings from this study will provide a strong foundation for developing and implementing a future intervention to improve the delivery of guideline-based HCC surveillance and treatment.

描述（由申请人提供）：肝细胞癌（HCC）是与癌症相关死亡的最快崛起原因。诊断为HCC后的生存率很差，除非早期检测到它并适用于阶段的治疗。临床实践指南概述HCC监视和HCC治疗的建议。尚无研究检查在高风险患者中基于指南的HCC监视的实施或结果，或者在患有HCC的患者中进行适当的治疗。目的：使用从VA行政数据库获得的数据以及使用VA补偿和养老金记录互换应用中从国家VA电子病历中抽象的信息，我们建议解决以下目的：1）检查基于指南的HCC监测的实施，在患有cirrhosis的患者以及与cirrhosian和Physician和Facitialial corlibil sumipal and Comporial and Cosepriald或Faceility corpape and Corlibal and Cosecill and Phanciild and Comporial saff中的实施中实施2）评估在HCC患者中基于指南的阶段治疗的实施，并检查与接受阶段适合治疗有关的患者，医师和设施因素； 3）检查基于指南的HCC监视和适合阶段的治疗对生存的影响。方法：我们提出了一项回顾性队列研究，使用两个分层的随机样本，约1,500例肝硬化患者和2006 - 2009年在全国VA设施中诊断出的1,500例HCC患者。 For Aim 1, the outcome will be appropriate (guideline-based surveillance, receipt of an imaging test unrelated to HCC surveillance, no surveillance) versus inappropriate (non-guideline based surveillance, overutilization of surveillance) implementation of HCC surveillance among patients with one of the four primary etiologies for cirrhosis (hepatitis C, non-alcoholic fatty liver disease,乙型肝炎，酒精性肝病）。将使用逻辑回归检查与适当实施HCC监视相关的患者，医师和设施因素。对于AIM 2，结果将是接受适合阶段的HCC治疗与阶段不合适的治疗，或者在HCC患者中没有治疗。根据当前的指南，将将每个患者分配给适合阶段的治疗类别，这将与接受的治疗进行比较。逻辑回归将用于检查接受适当治疗的预测指标。对于AIM 3，结果将是患有HCC的肝硬化患者的生存。收到适当的HCC监视和适合阶段的治疗将是感兴趣的主要预测指标。边缘结构建模将用于检查这些关联。影响：这项研究将研究尚未检查的HCC管理中的一个重要且及时的问题。这项研究的发现将为开发和实施未来的干预措施提供良好的基础，以改善基于指南的HCC监视和治疗。