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. 2022 Nov 1;23(11):3701-3715.
doi: 10.31557/APJCP.2022.23.11.3701.

Regional Differences in Admissions and Treatment Outcomes for Hepatocellular Carcinoma Patients in Thailand

Taya Kitiyakara  1 , Apinya Leerapun  2 , Chinnavat Sutthivana  3 , Kittiyod Poovorawan  4 , Wirichada Pan-Ngum  5 , Ngamphol Soonthornworasiri  5 , Roongruedee Chaiteerakij  6 , Sombat Treeprasertsuk  6 , Kamthorn Phaoswasdi  7 , Pisaln Mairiang  8 , Chomsri Kositchaiwat  1
Affiliations

Regional Differences in Admissions and Treatment Outcomes for Hepatocellular Carcinoma Patients in Thailand

Taya Kitiyakara et al. Asian Pac J Cancer Prev. .

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the commonest cancers in Thailand. We report the stage and survival of patients who were admitted under the public universal health fund (NHSO) covering 47 million people to determine if there were regional disparities in the treatment outcomes in the country.

Method: We used the 2009-2013 Nationwide Hospital Admission Data, Thailand. Patients with hepatocellular carcinoma (HCC) were identified by the ICD10 code C22.0. Procedures were identified by ICD9-CM codes, and deaths were confirmed from the NHSO database and the national citizen registry. Thailand is divided into 6 regions and Bangkok. Hospitals were identified according to their specific reimbursement codes. Survival time started from the day of first admission and was estimated using the Kaplan-Meier method. The statistical method used to compare regions was Chi-squared tests (Pearson, likelihood ratio, linear-by linear association and Mantel-cox).

Results: There were 36,956 HCC patients admitted during the study period. The overall median survival was 36 days. 1.63% of the patients had surgery, 0.96% had radiofrequency ablation (RFA), and 5.24% had trans-arterial chemoembolization (TACE). 90.24% did not have any tumor-specific therapy. The proportion of patients admitted for tumor-specific therapy vs. no tumor-specific therapy was significantly different between regions in all treatment modalities (p<0.01). Each treatment modality showed a wide range of median survival values across the regions (p<0.01). The best survival was seen in Bangkok, the South and the North (for surgery, RFA and TACE) and was often more than twice as long as the regions with the lowest survival, Central, East and West.

Conclusions: There was a large previously-unreported disparity in admissions and outcomes in Thailand for different treatment modalities for HCC. Bangkok and the South had the best treatment outcomes and often had median survivals more than twice as long as those in the West and East. Public policy to reduce this disparity will need to be implemented in the future.

Keywords: Chemoembolization; Hepatocellular carcinoma; Surgery; liver neoplasm; survival.

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Conflict of interest statement

The authors declare that they do not have any conflict of interest.

Figures

Figure 1
Figure 1
The Population of Thailand Registered with the NHSO, by Region
Figure 2
Figure 2
The Survival of HCC Patients in Thailand According to the Treatment Modality
Figure 3
Figure 3
The Proportion of Admitted HCC Patients in Each Region Undergoing Different Treatment Modalities
Figure 4
Figure 4
The Overall Survival of Patients with HCC Admitted in Each Region
Figure 5
Figure 5
Survival Curve for Patients Undergoing Surgery for HCC in Different Regions in Thailand
Figure 6
Figure 6
Survival Curve for Patients Undergoing RFA in Different Regions of Thailand
Figure 7
Figure 7
Survival Curve for Patients Undergoing TACE in Different Regions in Thailand
Figure 8
Figure 8
Survival Curve for Patients who did not Receive HCC-specific Treatment
See this image and copyright information in PMC

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