Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

The incidence of hepatocellular carcinoma (HCC) is increasing in the United States. Due to factors such as portal hypertension, tumor biology and a donor organ shortage the care of these patients remain highly specialized and complex. Multiple treatment options are available for HCC but their use and utility remains unknown. Methods: Using SEER-Medicare linked data, we identified 8570 patients diagnosed with HCC between 1991 and 2007. Treatments included resection, liver transplantation (LT), ablation or transarterial chemoembolization (TACE). Patients who received no or palliative-only treatment were grouped (NoTx). Demographic, clinical and tumor factors were examined as determinants of therapy. Univariate and multivariate analyses were performed to determine predictors of overall survival. Results: Median age was 74.9 years. HCC therapies included resection (n=745; 8.7%), LT (n=120; 1.4%), ablation (n=312; 3.6%), TACE (n=1214; 14.2%) and NoTx (n=6179; 72.1%). Of the 8570 patients, 68% were coded as White, 11.3% Asian, 3.8% Hispanic, and 8.4% Black. Only 13.7% of patients underwent localized therapy that was potentially curable (TX group; resection, ablation or LT). If tumors were <5cm in largest dimension, then 64% of patients underwent TX. In the NoTx group, 49% were not cirrhotic, 36% had tumors < 5cm and 21% were tumor stage I or II. Median survival for all HCC patients increased over time (2002-2005: 116 months, 1999-2001: 96 months, 1991-1998: 87 months). In multivariate regression analysis, patients who received any modality of treatment achieved some benefit compared to NoTx. Specifically, adjusted overall survival was greatest in the patients in the TX group: LT (HR 0.35; 95% CI 0.26-0.47), resection (HR 0.33, 95% CI 0.29-0.37) and ablation (HR 0.51, 95% CI 0.42-0.62). Conclusion: In the Medicare population, HCC patients who receive potentially curative therapy such as resection, LT, and ablation experienced a substantial survival advantage over their non-operative peers (NoTx). Despite evidence that many patients had favorable biological characteristics, less than 15% of patients diagnosed with HCC received any treatment. Barriers to treatment and its underutilization must be identified to improve survival in patients diagnosed with HCC in the United States.