Survival in untreated hepatocellular carcinoma: A national cohort study

• Published in: PloS one Vol. 16; no. 2; p. e0246143
• Main Authors: Kim, Young Ae, Kang, Danbee, Moon, Hyeyoung, Sinn, Donghyun, Kang, Minwoong, Woo, Sang Myung, Chang, Yoon Jung, Park, Boram, Kong, Sun-Young, Guallar, Eliseo, Shin, Soo-Yong, Gwak, Geunyeon, Back, Joung Hwan, Lee, Eun Sook, Cho, Juhee
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04-02-2021; Public Library of Science (PLoS)
• Subjects: Abandonment of care; Age; Antiviral agents; Biology and life sciences; Cancer; Cancer patients; Cancer therapies; Chronic infection; Codes; Cohort analysis; Comparative analysis; Design analysis; Editing; Epidemiology; Health care facilities; Health insurance; Hepatitis; Hepatitis B; Hepatitis C; Hepatocellular carcinoma; Hepatoma; Insurance; Liver; Liver cancer; Liver diseases; Medical examination; Medical prognosis; Medicine; Medicine and Health Sciences; Mortality; Patient outcomes; Patients; Policy research; Prevention; Prognosis; Public health; Refusal to treat (Medicine); Research design; Risk factors; Surgery; Viruses; South Korea; United States > US; Maryland; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246143

This study aimed to analyze the proportion, characteristics and prognosis of untreated hepatocellular carcinoma (HCC) patients in a large representative nationwide study. A cohort study was conducted using the National Health Insurance Service (NHIS) database in Korea. A total of 63,668 newly-diagnosed HCC patients between January 2008 and December 2013 were analyzed. Patients were categorized into treatment group and no treatment group using claim codes after HCC diagnosis. The proportion of untreated HCC patients was 27.6%, decreasing from 33.4% in 2008 to 24.8% in 2013. Compared to treated patients, untreated patients were more likely to be older (P < 0.001), female (P < 0.01), to have a distant SEER stage (P < 0.001), severe liver disease (P < 0.001), and lower income (P < 0.001). The fully-adjusted hazard ratio for all-cause mortality comparing untreated to treated patients was 3.11 (95% CI, 3.04-3.18). The risk of mortality was higher for untreated patients in all pre-defined subgroups, including those with distant SEER stage and those with severe liver disease. About one fourth of newly diagnosed HCC patients did not receive any HCC-specific treatment. Untreated patients showed higher risk of mortality compared to treated patients in all subgroups. Further studies are needed to identify obstacles for HCC treatment and to improve treatment rates.