Treatment Delays and Survival in Patients With Hepatocellular Carcinoma: A Multicenter Cohort Study.

Abstract

Although treatment delays have been reported for several cancers, fewer studies have described the prevalence, contributing factors, and impact on survival in patients with hepatocellular carcinoma (HCC). We aimed to evaluate these aspects in a multicenter cohort. We conducted a retrospective cohort study of patients diagnosed with HCC from 2010 to 2018 across 4 US health systems. Treatment delay was defined as the first treatment >90 days after HCC diagnosis. Univariable and multivariable logistic regression analyses were performed to identify factors associated with treatment delays. The association between treatment delay and overall survival was evaluated using multivariable Cox regression analysis. Among 1,561 eligible patients (median age 61.7 years, 75.0% men, 65.5% Barcelona Clinic Liver Cancer [BCLC] stage 0/A), treatment delays occurred in 357 (22.9%) patients. Treatment delays were most frequent with BCLC stage 0 (31.1%), followed by stage A (24.3%), stage B (22.6%), and stage C (13.6%). Men (OR 0.68, 95% CI 0.51-0.91) and patients with BCLC stage C HCC (vs stage A: OR 0.40, 95% CI 0.25-0.63) were less likely to experience delays, whereas those with BCLC stage 0 (vs stage A: OR 1.56, 95% CI 1.06-2.29) were more likely to experience delays. In a 6-month landmark analysis, survival did not differ between delayed vs timely treatment (HR 1.09, 95% CI 0.87-1.37). Median survival from the 6-month landmark was 12.1 months (IQR: 5.5-23.3) and 14.6 months (IQR: 5.1-30.0) for the treatment delay and timely treatment groups, respectively. Treatment delays exceeding 90 days occurred in over one-fifth of patients but were not associated with significant differences in survival.