Evaluating the Impact of Multi-Institutional Care in Early-Stage Hepatocellular Carcinoma: A Nationwide Analysis.

Abstract

Oncologic care received at more than one institution has been shown to negatively impact patient survival in gastric and rectal cancers. Our study evaluated the effect of multi-institutional care (MC) on time to treatment initiation (TTI) and survival in early-stage HCC. The National Cancer Database was queried for patients with Stage I and II HCC (2004-2020). Patients were categorized as single-institution care (SC) or multi-institutional care (MC). A negative binomial regression model was used to identify predictors of increased TTI. Survival analyses were estimated with the Kaplan-Meier method. Of 12,704 patients, 51% (n = 6471) received MC and 49% (n = 6233) SC. MC patients were more often older (p < 0.0001), White (p < 0.0001), privately insured (p < 0.0001), and traveling greater distances (p = 0.0001). Median TTI was longer for MC patients than SC (61 vs. 50 days; p < 0.0001). Black, underinsured (Medicaid/other government insurance), and MC patients were associated with increased TTI by factors of 1.131 (95% CI: 1.093-1.170; p < 0.0001), 1.081 (95% CI: 1.046-1.119; p < 0.0001), and 1.203 (95% CI: 1.176-1.231; p < 0.0001). Survival was similar between MC and SC at 1 year (p = 0.1514) and 5 years (p = 0.1769). Despite increased treatment time, there was no appreciable survival disadvantage among patients receiving care at multiple sites.