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: 7812042
• 负责人: Nader Nabile Massarweh
• 金额: $ 5.37万
• 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 2010-06-24
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7812042
• 关键词: Ablation; Adoption; Caring; Characteristics; Clinical; Clinical Trials; Cohort Studies; Communities; Data; Diagnosis; Disease; Early treatment; Environment; Epidemic; Excision; Future; Geographic Locations; Goals; Hepatic; Hepatitis C; Hospitals; Incidence; Intervention; Link; Liver neoplasms; Logistic Regressions; Malignant Neoplasms; Medicare; Medicare claim; Morbidity - disease rate; Operative Surgical Procedures; Organ; Outcome; Outpatients; Patients; Physicians; Platelet Factor 4; Primary carcinoma of the liver cells; Procedures; Provider; Radiation; Radiofrequency Interstitial Ablation; Relative (related person); Research; Resources; Role; Safety; Solid; Staging; Surgeon; Surgical Management; Survival Rate; Techniques; Testing; Time; Tissues; Training; Transplantation; Uncertainty; United States; Variant; Work; advanced disease; cancer care; chemotherapy; cohort; improved; interest; liver transplantation; minimally invasive; mortality; neoplasm registry; new technology; palliative; population based; 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 20 世纪 70 年代和 1980 年代丙型肝炎流行的结果，这种癌症的发病率在过去十年中在美国翻了一番，全世界每年诊断出约 100 万新病例。传统上，早期 HCC 的治疗方法是手术。然而，射频消融 (RFA) 最近在 HCC 治疗中越来越受欢迎。与手术治疗相比，射频消融具有许多潜在的优势。它可以通过微创方法应用，可以作为门诊手术进行，允许在没有资源进行手术切除或移植的护理环境中治疗 HCC，并允许非手术从业者（例如介入放射科医生）治疗 HCC 患者的机会。 RFA 成功地消融了组织，但其作为 HCC 主要治疗方法的功效尚未经过充分测试。整个社区如何利用 RFA 也不得而知。最近的数据表明 RFA 正在成为早期 HCC 的主要治疗选择，但没有高质量的证据支持这种做法。拟议的研究打算使用大型的、基于人群的癌症登记处 (SEER) 以及关联的医疗保险索赔数据 (SEER-Medicare) 来更好地定义整个社区如何治疗 HCC，以检测 RFA 使用趋势，并评估与 HCC 护理相关的结果。通过使用 1992 年至 2005 年间诊断为 HCC 的患者队列，我们​​计划 1.) 描述 RFA 使用的特定阶段时间趋势； 2.) 描述与使用 RFA 相关的区域差异以及患者和医生/医院层面的因素； 3.) 描述在调整相关因素后接受 RFA 的患者与接受手术治疗的患者之间 30 天死亡率的差异； 4.) 描述在调整相关因素后，接受 RFA 的早期 HCC 患者与接受手术治疗的患者总体生存率和病因特异性生存率的差异。逻辑回归将用于检查 RFA 使用随时间变化的趋势，并评估 RFA 使用的潜在预测因素。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因素。 Cox 多元回归将用于探讨 RFA 使用与长期生存之间的关系，同时调整分期以及患者和提供者因素。这项工作对于提高手术护理质量具有重要意义，这些发现将有助于为未来的前瞻性临床试验提供信息，这些试验旨在阐明 RFA 在 HCC 治疗中的作用

项目成果

Diagnostic imaging and biopsy use among elderly medicare beneficiaries with hepatocellular carcinoma.

患有肝细胞癌的老年医疗保险受益人的诊断成像和活检的使用。

• DOI: 10.1200/jop.2010.000116
• 发表时间: 2011
• 期刊: Journal of oncology practice
• 作者: Massarweh,NaderN;Park,JamesO;Bruix,Jordi;Yeung,RaymondSW;Etzioni,RuthB;Symons,RebeccaGaston;Baldwin,Laura-Mae;Flum,DavidR
• 通讯作者: Flum,DavidR