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Mo1489 Are Double Layer Stents Better Than Plastic Stents for Malignant Biliary Strictures? A Meta-Analysis and Systematic Review
HCC BCLC stage C of the three tertiary hospitals in Korea were analyzed retrospectively. The variables affecting overall survival (OS) were analyzed and the subclassification was performed. Results: The median follow up duration was 4.2 months (interquartile range: 1.8-11.0). Tumor number (Hazard ratio [HR] 1.051, p=.002), tumor size (HR 1.082, p<.001), major vessel invasion (portal vein or hepatic vein invasion, HR 1.732, p<.001), distant metastasis (HR 1.704, p<.001), Child-Pugh grade (HR 1.298, p<.019), MELD score (HR 1.076, p<.001) proved to be independently associated with OS by multivariate analysis. Subclassification was made up of major vessel invasion (MVI) and distant metastasis (M) which had the highest hazard ratios. The median OS of 22.7 (95% confidence interval [CI] 10.2-35.1), 6.9 (95% CI 5.8-8.0), and 3.6 ( 95% CI 2.6-4.6) months were observed in patients with neither MVI nor M (n=106), with MVI but no M (n=383), and with M regardless of MVI (n=141), respectively (p<0.001). Conclusion: Patients' survival was significantly different among the proposed BCLC substages. Subclassification of BCLC stage C by major vessel invasion and distant metastasis could be useful for discriminating patient prognosis and guiding treatment strategies for HCC.
Mo1487
AASLD Abstracts
Rising Hospital Charges and Inpatient Encounters for Patients with Hepatocellular Carcinoma (HCC) Alexander L. Nguyen, Pauline Nguyen, Edward Sheen, Mingjuan Jin, Mindie H. Nguyen Background: HCC is the second leading cause of cancer-related death in men in the world and sixth leading cause for women, but its economic burden has not been well characterized. Our aim was to estimate the economic burden of liver cancer using the sum of hospital charges and the number of hospital encounters for patients with HCC admitted to hospitals in California, the most populous state in the US, with an ethnically diverse population of 38.8 million people. Methods: We used de-identified data from the California Patient Discharge Database from 2005 to 2013 for 35,606,218 encounters of patients with liver diseases. Each inpatient discharge was defined as an encounter while total charges was defined as all inpatient hospital charges for service rendered during the length of stay for an encounter in US dollars ($). We used ICD-9 diagnosis codes to identify 60,906 hospital encounters for analysis with a principal or secondary diagnosis of HCC. We examined charges and encounters by age, sex, ethnicity, race, and payment source. We then analyzed the data by related diagnoses of HCV, HBV, alcohol related, NAFLD or other liver disease, and unknown disease. Results: Total hospital charges for patients with HCC from 2005 to 2013 were $4.8 billion, with the majority of patient encounters being male (71%), selfidentified as white (53%), of Hispanic ethnicity (30%), and aged 40 to 64 years (52%). Payment sources included Medicare (44%), California's Medicaid program (23%), private insurance (27%), and other coverage (6%). Total charges increased significantly (p<0.0001) by 237% from $320 million in 2005 to $760 million in 2013 while the number of encounters also increased from 5,184 to 8,014 (Figure 1a). The total charges by race and ethnicity showed Whites made up 55% of charges, Blacks 7%, Hispanics 28%, Asians 24%, and other races 4% (Figure 1b). Charges by age were 7% for age 0 to 39, 56% for age 40 to 64, and 37% for age 65 and above (Figure 2a). From 2005 to 2013, patients with HCC and an associated diagnosis of HCV accrued $2.3 billion in charges (47% of total charges), those patients with HBV accrued $700 million (15%), alcohol related $854 million (18%), other liver disease including NAFLD $183 million (4%), and unknown $800 million (16%) (Figure 2b). Conclusions: The economic burden of HCC is substantial and increasing in this large population-based cohort of patients in the United States, as clearly demonstrated by the rising number of hospital encounters and total charges. Analysis by ethnicity and race indicated Whites to be the most frequently represented race and Hispanics as the most frequently represented ethnicity. HCC due to HCV was most predominantly seen in this study representing 47% of hospital related charges. Early linkage to targeted preventive care for these populations will help decrease the economic costs of HCC in California.
Mo1489 Are Double Layer Stents Better Than Plastic Stents for Malignant Biliary Strictures? A Meta-Analysis and Systematic Review Harsha Moole, Matthew L. Bechtold, Srinivas R. Puli Background: Double layer stents (DLS) were designed to overcome the limitations of plastic stents (PS) when used for palliating inoperable malignant biliary strictures. There have been recent retrospective studies and randomized controlled trials that evaluated the clinical efficacy of DLS and PS. This is a meta-analysis to pool the evidence for DLS versus PS in managing inoperable malignant biliary strictures. Aims: Compare DLS and PS in inoperable malignant biliary strictures. Primary outcomes are stent patency period (in days), stent occlusion rates and over all adverse effects. Methods: Study Selection Criteria: Studies using DLS and PS for palliation in patients with inoperable malignant biliary strictures. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement. Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochrans Q test based upon inverse variance weights. Results: Initial search identified 374 reference articles, of which 41 were selected and reviewed. Five studies (N=460) for DLS and PS which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed DLS patency to be 118.9 days (95% CI = 110.4 to 127.4) compared to 77.4 days (95% CI = 70.2 to 84.6) in PS. Percentage of stents occluded in DLS and PS group were 8.1% (95% CI = 7.1 to 9.0) and 37.5% (95% CI = 33.8 to 41.1) respectively. Overall adverse events in DLS group and PS group were 4.62 (95% CI = 4.22 to 5.02) and 3.44 (95% CI = 2.99 to 3.89) respectively. The pooled effects estimated by fixed and random effect models were similar. The p for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. Conclusions: DLS remain patent for a longer duration and are less prone to occlusion compared to PS. DLS had slightly higher overall adverse effects compared to PS, however this may be in part due to their prolonged patency period and event accumulation over this time.
Mo1488 Subclassification of Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma by Major Vessel Invasion and Distant Metastasis Seong Kyun Na, Dongwon Lee, Hyung Joon Yim, Seung Young Kim, Sang Jun Suh, Jong Jin Hyun, Sung Woo Jung, Young Kul Jung, Ja Seol Koo, Ji Hoon Kim, Yeon Seok Seo, Jong Eun Yeon, Sang Woo Lee, Kwan Soo Byun, Soon Ho Um Background and Aim: The hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer (BCLC) stage C encompasses a wide range of disease with various prognosis. We aimed to subclassify the BCLC stage C for prediction of patients' prognosis. Patients and methods: From January 2004 to December 2012, total 630 patients with newly diagnosed
AASLD Abstracts
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Mo1487
AASLD Abstracts
Rising Hospital Charges and Inpatient Encounters for Patients with Hepatocellular Carcinoma (HCC) Alexander L. Nguyen, Pauline Nguyen, Edward Sheen, Mingjuan Jin, Mindie H. Nguyen Background: HCC is the second leading cause of cancer-related death in men in the world and sixth leading cause for women, but its economic burden has not been well characterized. Our aim was to estimate the economic burden of liver cancer using the sum of hospital charges and the number of hospital encounters for patients with HCC admitted to hospitals in California, the most populous state in the US, with an ethnically diverse population of 38.8 million people. Methods: We used de-identified data from the California Patient Discharge Database from 2005 to 2013 for 35,606,218 encounters of patients with liver diseases. Each inpatient discharge was defined as an encounter while total charges was defined as all inpatient hospital charges for service rendered during the length of stay for an encounter in US dollars ($). We used ICD-9 diagnosis codes to identify 60,906 hospital encounters for analysis with a principal or secondary diagnosis of HCC. We examined charges and encounters by age, sex, ethnicity, race, and payment source. We then analyzed the data by related diagnoses of HCV, HBV, alcohol related, NAFLD or other liver disease, and unknown disease. Results: Total hospital charges for patients with HCC from 2005 to 2013 were $4.8 billion, with the majority of patient encounters being male (71%), selfidentified as white (53%), of Hispanic ethnicity (30%), and aged 40 to 64 years (52%). Payment sources included Medicare (44%), California's Medicaid program (23%), private insurance (27%), and other coverage (6%). Total charges increased significantly (p<0.0001) by 237% from $320 million in 2005 to $760 million in 2013 while the number of encounters also increased from 5,184 to 8,014 (Figure 1a). The total charges by race and ethnicity showed Whites made up 55% of charges, Blacks 7%, Hispanics 28%, Asians 24%, and other races 4% (Figure 1b). Charges by age were 7% for age 0 to 39, 56% for age 40 to 64, and 37% for age 65 and above (Figure 2a). From 2005 to 2013, patients with HCC and an associated diagnosis of HCV accrued $2.3 billion in charges (47% of total charges), those patients with HBV accrued $700 million (15%), alcohol related $854 million (18%), other liver disease including NAFLD $183 million (4%), and unknown $800 million (16%) (Figure 2b). Conclusions: The economic burden of HCC is substantial and increasing in this large population-based cohort of patients in the United States, as clearly demonstrated by the rising number of hospital encounters and total charges. Analysis by ethnicity and race indicated Whites to be the most frequently represented race and Hispanics as the most frequently represented ethnicity. HCC due to HCV was most predominantly seen in this study representing 47% of hospital related charges. Early linkage to targeted preventive care for these populations will help decrease the economic costs of HCC in California.
Mo1489 Are Double Layer Stents Better Than Plastic Stents for Malignant Biliary Strictures? A Meta-Analysis and Systematic Review Harsha Moole, Matthew L. Bechtold, Srinivas R. Puli Background: Double layer stents (DLS) were designed to overcome the limitations of plastic stents (PS) when used for palliating inoperable malignant biliary strictures. There have been recent retrospective studies and randomized controlled trials that evaluated the clinical efficacy of DLS and PS. This is a meta-analysis to pool the evidence for DLS versus PS in managing inoperable malignant biliary strictures. Aims: Compare DLS and PS in inoperable malignant biliary strictures. Primary outcomes are stent patency period (in days), stent occlusion rates and over all adverse effects. Methods: Study Selection Criteria: Studies using DLS and PS for palliation in patients with inoperable malignant biliary strictures. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement. Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochrans Q test based upon inverse variance weights. Results: Initial search identified 374 reference articles, of which 41 were selected and reviewed. Five studies (N=460) for DLS and PS which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed DLS patency to be 118.9 days (95% CI = 110.4 to 127.4) compared to 77.4 days (95% CI = 70.2 to 84.6) in PS. Percentage of stents occluded in DLS and PS group were 8.1% (95% CI = 7.1 to 9.0) and 37.5% (95% CI = 33.8 to 41.1) respectively. Overall adverse events in DLS group and PS group were 4.62 (95% CI = 4.22 to 5.02) and 3.44 (95% CI = 2.99 to 3.89) respectively. The pooled effects estimated by fixed and random effect models were similar. The p for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. Conclusions: DLS remain patent for a longer duration and are less prone to occlusion compared to PS. DLS had slightly higher overall adverse effects compared to PS, however this may be in part due to their prolonged patency period and event accumulation over this time.
Mo1488 Subclassification of Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma by Major Vessel Invasion and Distant Metastasis Seong Kyun Na, Dongwon Lee, Hyung Joon Yim, Seung Young Kim, Sang Jun Suh, Jong Jin Hyun, Sung Woo Jung, Young Kul Jung, Ja Seol Koo, Ji Hoon Kim, Yeon Seok Seo, Jong Eun Yeon, Sang Woo Lee, Kwan Soo Byun, Soon Ho Um Background and Aim: The hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer (BCLC) stage C encompasses a wide range of disease with various prognosis. We aimed to subclassify the BCLC stage C for prediction of patients' prognosis. Patients and methods: From January 2004 to December 2012, total 630 patients with newly diagnosed
AASLD Abstracts
X : 10052$CH02 03-28-16 22:36:37 PDFd : 10052B : e
S-1128
Page 1128