Back

Sunday Poster Session

Category: Liver

P0702 - Who Refuses Surgery for Hepatocellular Carcinoma? A National Cancer Database Study

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Usman Tariq, MD

Allegheny Health Network
Pittsburgh, PA, United States

Usman Tariq, MD¹, Azeem Malik, MD², Rahul Karna, MD¹, Bandhul Hans, MD¹, Heitham Abdul-Baki, MD¹
¹Allegheny Health Network, Pittsburgh, PA; ²The Ohio State University Wexner Medical Center, Columbus, OH

Introduction: The purpose of this study was to identify patient-level, tumor-level, and treatment-level factors associated with refusal of surgery in patients with hepatocellular carcinoma.

Methods: The 2004 to 2015 National Cancer Database was queried to identify patients with hepatocellular carcinoma who either received or declined surgery. Multivariable logistic regression analyses were used to identify factors associated with denying surgical intervention.

Results: A total of 46,419 patients with hepatocellular carcinoma were offered surgical intervention(s) of which 1568 (3.4%) refused surgery. Factors associated with increased odds of refusing surgery included advancing age (p< 0.001), African-American race (OR 1.30 [1.10-1.53]; p=0.002), living in a poorly educated area (OR 1.24 [1.05-1.46]; p=0.01), Charlson-comorbidity index ≥3 (OR 1.22 [1.03-1.43]; p=0.02), clear cell histology (OR 0.40 [0.18-0.89]; p=0.02), and advancing stage at diagnosis (p< 0.001) and those receiving palliative care (OR 5.33 [4.01-7.05]; p< 0.001). Factors associated with decreased odds of rejecting surgery included having medical insurance (p< 0.001), living in the south-Atlantic (OR 0.71 [0.54-0.92]; p=0.01) or pacific (OR 0.54 [0.41-0.71]; p< 0.001) regions, receiving care at a comprehensive cancer/academic/integrated cancer center (p< 0.001), increasing distance from treatment facility (p< 0.001), Grade II or less (p< 0.05) and receiving chemotherapy (OR 0.34 [0.29-0.39]; p< 0.001).

Discussion: Multiple demographic and disease-associated disparities influence the refusal of surgery. Further studies are required to understand the associations between these factors and patient refusal. This can help facilitate discussions between physicians and patients to assist in informed decision-making for further treatments.

Factors

Adjusted Odds Ratio [8] and 95% CI

P-value

Age

0-39

40-64

65-89

≥90

Ref.

8.72 [4.41-17.5]

16.981 [8.50-34.00]

162.12 [73.42-358.00]

< 0.001

Race

White

African American

American Indian

Asian

Pacific Islander

Others

Unknown

Ref.

1.30 [1.10-1.53]

0.90 [0.95-2.07]

1.13 [0.91-1.34]

1.67 [0.70-4.00]

0.65 [0.37-1.16]

1.28 [0.80-2.07]

0.002

0.904

0.256

0.248

0.143

0.307

Insurance

Uninsured

Private Insurance

Medicaid

Medicare

Other government

Unknown

Ref.

0.35 [0.20-0.32]

0.53 [0.40-0.70]

0.46 [0.35-0.60]

0.18 [0.10-0.35]

0.36 [0.22-0.58]

< 0.001

Education

≥21%

13-20.9%

7-12.9%

< 7%

Unknown

Ref.

1.24 [1.05-1.46]

1.13 [0.97-1.37]

0.94 [0.75-1.21]

0.87 [0.09-8.67]

0.01

0.20

0.70

0.90

Income

< $38,000

$38,000-$47,999

$48,000-$62,999

≥$63,000

Unknown

Ref.

0.90 [0.75-1.06]

0.68 [0.57-0.83]

0.72 [0.58-0.90]

1.23 [0.13-11.388]

0.19

< 0.001

0.05

0.86

Geographical Location

New England

Mid-Atlantic

South-Atlantic

East-North Central

East-South Central

West-North Central

West -South Central

Mountain

Pacific

Ref.

1.00 [0.77-1.23]

0.71 [0.54-0.92]

0.96 [0.74-1.24]

0.70 [0.50-0.98]

1.36 [1.01-1.85]

0.80 [0.60-1.05]

1.06 [0.76-1.49]

0.54 [0.41-0.71]

0.97

0.01

0.74

0.04

0.05

0.11

0.73

< 0.001

Rural/Urban

Metropolitan/Urban

Rural

Unknown

Ref.

0.68 [0.36-1.29]

0.64 [0.43-0.97]

0.24

0.04

Facility Type

Community Cancer Center

Comprehensive Community Cancer Center

Academic/Research Program

Integrated Network Cancer Program

Ref.

0.57 [0.47-0.73]

0.21 [0.17-0.27]

0.35 [0.27-0.46]

< 0.001

Distance from Facility (in miles)

0-10

11-50

51-100

≥101

Unknown

Ref.

0.60 [0.53-0.67]

0.37 [0.29-0.47]

0.23 [0.17-0.32]

0.69 [0.49-0.97]

< 0.001

0.03

Comorbidity Index

≥3

Ref.

0.90 [0.79-1.04]

0.94 [0.78-1.13]

1.22 [1.03-1.43]

0.15

0.52

0.02

Histology

Hepatocellular

Adenocarcinoma

Fibrolamellar

Scirrhous

Spindle

Clear cell

Others

Ref.

1.31 [0.89-1.93]

0.16 [0.02-1.16]

1.10 [0.32-3.8]

0.40 [0.18-0.89]

1.10 [0.92-1.33]

0.17

0.07

0.88

0.02

0.31

Grade

III

Unknown

Ref.

0.51 [0.41-0.64]

0.67 [0.51-0.86]

0.41 [0.17-1.01]

3.62 [3.05-4.30]

< 0.001

0.002

0.053

< 0.001

Stage

III

Unknown

Ref.

0.99 [0.84-1.17]

1.72 [1.33-2.08]

4.81 [3.86-5.98]

2.64 -2.28-3.06]

0.90

< 0.001

Chemotherapy

Did not receive

Received

Unknown

Ref.

0.34 [0.29-0.39]

0.39 [0.25-0.60]

< 0.001

Palliative Care

Did not receive

Received

Unknown

Ref.

5.33 [4.01-7.05]

1.75 [0.37-8.23]

< 0.001

0.48

Table: Table 1: Factors Influencing Rejection of Surgical Intervention in Patients with Hepatocellular Carcinoma

Disclosures:

Usman Tariq indicated no relevant financial relationships.

Azeem Malik indicated no relevant financial relationships.

Rahul Karna indicated no relevant financial relationships.

Bandhul Hans indicated no relevant financial relationships.

Heitham Abdul-Baki indicated no relevant financial relationships.

Usman Tariq, MD¹, Azeem Malik, MD², Rahul Karna, MD¹, Bandhul Hans, MD¹, Heitham Abdul-Baki, MD¹. P0702 - Who Refuses Surgery for Hepatocellular Carcinoma? A National Cancer Database Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.