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Primary Liver Cancer: An NCDB Analysis of Overall Survival and Margins After Hepatectomy

  • Christopher Coon
  • Nicholas Berger
  • Dan Eastwood
  • Susan Tsai
  • Kathleen Christians
  • Harveshp Mogal
  • Callisia Clarke
  • T. Clark GamblinEmail author
Hepatobiliary Tumors
  • 30 Downloads

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) constitute the majority of primary liver cancers. This retrospective review aimed to determine whether site of care is a significant predictor of patient outcome after hepatectomy as measured by overall survival, hazard ratios (HRs), and resection margin status.

Methods

Data regarding patients with a new diagnosis of ICC and HCC who underwent hepatectomy were analyzed from the national cancer database. The patients were divided into two cohorts: those receiving treatment at academic cancer centers (ACCs) and those receiving treatment at community cancer centers (CCCs). The study adjusted for confounding variables and selection bias using propensity score matching. Median overall survival (months), hazard ratios, and resection margin status (R0, R1/R2, unknown) were examined.

Results

The inclusion criteria were met by 10,463 patients. After propensity matching, 5600 patients remained, with half receiving treatment at ACCs and half at CCCs. Median overall survival from the date of diagnosis for patients undergoing hepatectomy was longer at ACCs than at CCCs (28.3 vs 24.8 months; p < 0.001). Additionally, multivariable Cox proportional hazards models showed that treatment at CCCs was associated with poorer survival than treatment at ACCs (HR, 1.226; 95% confidence interval [CI], 1.142–1.316; p < 0.0001). Treatment facility designation also was a predictive indicator of resection margin status, with patients at CCCs exhibiting higher odds of R1/R2 resections (odds ratio [OR], 1.41; 95% CI, 1.19–1.67; p < 0.0001).

Conclusion

Hepatectomy for ICC and HCC performed at ACCs was associated with improved outcomes compared with CCCs. Centralization of care to ACCs may lead to improved patient outcomes.

Notes

Disclosure

There are no conflicts of interest.

References

  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.  https://doi.org/10.1002/ijc.29210.CrossRefGoogle Scholar
  2. 2.
    Liver and Intrahepatic Bile Duct Cancer–Cancer Stat Facts. Retrieved 2 August 2018 at https://seer.cancer.gov/statfacts/html/livibd.html.
  3. 3.
    Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al. (eds). SEER Cancer Statistics Review, 1975–2015, National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2015/.
  4. 4.
    Petrick JL, Kelly SP, Altekruse SF, McGlynn KA, Rosenberg PS. Future of hepatocellular carcinoma incidence in the United States forecast through 2030. J Clin Oncol. 2016;34:1787–94.  https://doi.org/10.1200/jco.2015.64.7412.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Buettner S, van Vugt JL, IJzermans JN, Groot Koerkamp B. Intrahepatic cholangiocarcinoma: current perspectives. OncoTargets Ther. 2017;10:1131–42.  https://doi.org/10.2147/ott.s93629.CrossRefGoogle Scholar
  6. 6.
    Fong ZV, Tanabe KK. The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: a comprehensive and evidence-based comparison and review. Cancer. 2014;120:2824–38.  https://doi.org/10.1002/cncr.28730.CrossRefPubMedGoogle Scholar
  7. 7.
    Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–37.  https://doi.org/10.1056/nejmsa1010705.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. Retrieved 2 August 2018, from http://dx.doi.org/10.1056/NEJMsa012337.  https://doi.org/10.1056/nejmsa012337.
  9. 9.
    Enomoto LM, Gusani NJ, Dillon PW, Hollenbeak CS. Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2014;18:690–700.  https://doi.org/10.1007/s11605-013-2422-z.CrossRefGoogle Scholar
  10. 10.
    Chang C-M, Yin W-Y, Wei C-K, Lee C-H, Lee C-C. The combined effects of hospital and surgeon volume on short-term survival after hepatic resection in a population-based study. PloS One. 2014;9:e86444.  https://doi.org/10.1371/journal.pone.0086444.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schneider EB, Ejaz A, Spolverato G, et al. Hospital volume and patient outcomes in hepato-pancreatico-biliary surgery: is assessing differences in mortality enough? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2014;18:2105–15.  https://doi.org/10.1007/s11605-014-2619-9.CrossRefGoogle Scholar
  12. 12.
    Hsu RCJ, Salika T, Maw J, Lyratzopoulos G, Gnanapragasam VJ, Armitage JN. Influence of hospital volume on nephrectomy mortality and complications: a systematic review and meta-analysis stratified by surgical type. BMJ Open. 2017;7:e016833.  https://doi.org/10.1136/bmjopen-2017-016833.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schrag D, Panageas KS, Riedel E, et al. Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol. 2003;83:68–78; discussion 78–79.  https://doi.org/10.1002/jso.10244.
  14. 14.
    Schrag D, Earle C, Xu F, et al. Associations between hospital and surgeon procedure volumes and patient outcomes after ovarian cancer resection. J Natl Cancer Inst. 2006;98:163–171.  https://doi.org/10.1093/jnci/djj018.CrossRefPubMedGoogle Scholar
  15. 15.
    Lin H-C, Lin C-C. Surgeon volume is predictive of 5-year survival in patients with hepatocellular carcinoma after resection: a population-based study. J Gastrointest Surg. 2009;13:2284–91.  https://doi.org/10.1007/s11605-009-0990-8.CrossRefPubMedGoogle Scholar
  16. 16.
    Gani F, Azoulay D, Pawlik TM. Evaluating trends in the volume–outcomes relationship following liver surgery: does regionalization benefit all patients the same? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2017;21:463–71.  https://doi.org/10.1007/s11605-016-3316-7.CrossRefGoogle Scholar
  17. 17.
    Hyder O, Sachs T, Ejaz A, Spolverato G, Pawlik TM. Impact of hospital teaching status on length of stay and mortality among patients undergoing complex hepatopancreaticobiliary surgery in the USA. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2013;17:2114–22.  https://doi.org/10.1007/s11605-013-2349-4.CrossRefGoogle Scholar
  18. 18.
    Lafaro K, Grandhi MS, Herman JM, Pawlik TM. The importance of surgical margins in primary malignancies of the liver. J Surg Oncol. 2016;113:296–303.  https://doi.org/10.1002/jso.24123.CrossRefPubMedGoogle Scholar
  19. 19.
    National Cancer Database. American College of Surgeons. Retrieved 1 August 2018 at https://www.facs.org/quality-programs/cancer/ncdb.
  20. 20.
    American College of Surgeons. Quality Programs. National Cancer Database. Participant User Files. Version: PUF 2014. Retrieved 2 August 2018 from https://www.facs.org/~/media/files/quality%20programs/cancer/ncdb/puf%20data%20dictionary%20version%20puf%202014.ashx.
  21. 21.
    Kosanke, J., Bergstralh, E. (2004, March). Division of Biomedical Statistics and Informatics—Mayo Clinic Research. Retrieved 6 June 2016, from http://bioinformaticstools.mayo.edu/research/vmatch/.
  22. 22.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51.  https://doi.org/10.1001/jama.280.20.1747.CrossRefPubMedGoogle Scholar
  23. 23.
    Aquina CT, Probst CP, Becerra AZ, et al. High volume improves outcomes: the argument for centralization of rectal cancer surgery. Surgery. 2016;159:736–48.  https://doi.org/10.1016/j.surg.2015.09.021.CrossRefPubMedGoogle Scholar
  24. 24.
    Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med Care. 2010;48:1041.  https://doi.org/10.1097/mlr.0b013e3181f37d5f.CrossRefPubMedGoogle Scholar
  25. 25.
    Simunovic M, Rempel E, Thériault M-E, et al. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg. 2006;49:251–8.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Gooiker GA, Gijn W van, Wouters MWJM, Post PN, Velde CJH van de, Tollenaar R a. EM. Systematic review and meta-analysis of the volume–outcome relationship in pancreatic surgery. BJS. 2011;98:485–94.  https://doi.org/10.1002/bjs.7413.
  27. 27.
    Buettner S, Gani F, Amini N, et al. The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery. 2016;159:1004–12.  https://doi.org/10.1016/j.surg.2015.10.025.CrossRefPubMedGoogle Scholar
  28. 28.
    Massarweh NN, El-Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control J Moffitt Cancer Cent. 2017;24.  https://doi.org/10.1177/1073274817729245.
  29. 29.
    Hill JS, McPhee JT, Messina LM, Ciocca RG, Eslami MH. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era. J Vasc Surg. 2008;48:29–36.e1.  https://doi.org/10.1016/j.jvs.2008.02.048.CrossRefGoogle Scholar
  30. 30.
    Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference? A follow-up analysis of another decade. Ann Surg. 2009;250:472–83.  https://doi.org/10.1097/sla.0b013e3181b47c79.CrossRefPubMedGoogle Scholar
  31. 31.
    Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Montie JE, Wei JT. The regionalization of radical cystectomy to specific medical centers. J Urol. 2005;174(4 Pt 1):1385–9; discussion 1389.Google Scholar
  32. 32.
    Miura JT, Johnston FM, Tsai S, et al. Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis. HPB. 2015;17:896–901.  https://doi.org/10.1111/hpb.12446.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS ONE. 2014;9:e84484.  https://doi.org/10.1371/journal.pone.0084484.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Christopher Coon
    • 1
  • Nicholas Berger
    • 1
  • Dan Eastwood
    • 2
  • Susan Tsai
    • 1
  • Kathleen Christians
    • 1
  • Harveshp Mogal
    • 1
  • Callisia Clarke
    • 1
  • T. Clark Gamblin
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  2. 2.Division of BiostatisticsMedical College of WisconsinMilwaukeeUSA

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