A. Mokdad1, A. Singal1, J. Mansour1, G. Balch1, M. Choti1, A. Yopp1 1University Of Texas Southwestern Medical Center,Surgery Oncology,Dallas, TX, USA
Introduction: Primary liver cancer is the fastest growing cause of cancer related deaths in the United States and affects patients disproportionately in lower socioeconomic classes. The purpose of this study was to determine if patients with primary liver cancer who present at safety-net hospitals (SNHs) have a different presentation and prognosis compared to those presenting at non-SNHs.
Methods: We conducted a retrospective analysis of patients with primary liver cancer identified in the Texas Cancer Registry between 1995 and 2010. SNH was defined as a hospital with a Disproportionate Share Hospital index greater than 0.15. Demographics, tumor characteristics, treatment regimens, and survival were compared between patients presenting at SNHs and non-SNHs. Univariate analyses were conducted using student’s t-test and log-rank test. Statistically significant variables were included in a Cox-regression model.
Results: Of the 20,259 patients diagnosed with primary liver cancer, 4,580 (24.3%) presented to SNHs. Patients presenting at a SNH were more likely to be Hispanic (61% vs. 29%, p<0.001) and have lower socioeconomic status (63% vs. 35%, p<0.001) compared to patients presenting at non-SNH. Tumor stage at presentation was similar in both hospital categories; 7,149 (51.9%) presented with local disease, 3,369 (24.5%) with regional spread, and 3,249 (23.6) with metastasis. Patients were 1.5 times (OR = 1.53, P < 0.001) more likely to have a procedure or receive chemotherapy and/or radiotherapy at a non-safety net hospital. The median survival for patients with liver cancer at a SNH was 33 days shorter compared that at non-safety net hospitals, 137 versus 170 days, respectively (P < 0.001). Survival was associated with age, sex, race, tumor stage, socioeconomic status, and treatment. After adjusting for patient demographics and tumor characteristics, patients in safety-net hospitals had an 8% (HR = 1.08, P = 0.001) increased mortality compared to patients in non-safety net hospitals. This greater risk was rendered non-significant (HR = 1.01, P = 0.82) when reception of a procedure, radiation, and/or chemotherapy was accounted for.
Conclusion: Patients with primary liver cancer who present to a SNH are more likely to be Hispanic and have a worse overall survival despite similar stage of tumor presentation.