Purpose: To compare the outcome of veterans with hepato-cellular carcinoma (HCC) compared with that of the non-veteran population.
Background: Hepatitis and HCC screening are routine in VA facilities. We hypothesized that VA subjects with HCC are diagnosed at earlier stages and tend to receive more loco-regional treatment compared with that of nonveteran patients.
Methods: Veterans with HCC were identified from the VISN 16 tumor registry data from 2007 to 2012. Stage, treatment characteristics, and survival data were collected. VA data were compared with published results from the Surveillance, Ep-idemiology, and End Results (SEER) population, spanning from 1998 to 2008. Disease stages were classified as local (American Joint Committee on Cancer [AJCC] stages I, II, IIIA, IIIB), regional (AJCC stages IIIC and IVA), and distant/ unknown (AJCC stages IV, IVB, and unknown). Paired t test for continuous variables and a chi-square test for categorical ones were performed.
Results: One thousand thirty-five VA patients with HCC were identified, and 53.1% of the cases had biopsy confirmation. The median age was 60 years (range 43-93); 99.4% were male; 63.4% were white, and 34.6% were African American; 76.4% had a history of alcohol use; 47.3% were positive for hepatitis C; 2.1% were positive for hepatitis B; and 1.1% were positive for both. At diagnosis, 74.4% had local, 7.2% had regional, and 7.6% had distant disease; 30.5% received loco-regional treatment at first (5.7% surgical resection, 1.2% ethanol ablation, 22.2% only transarterial chemoembolization [TACE], 1.5% other local tumor-destruction thera-pies). Sorafenib was used in 19.2% patients. Median overall survival of all subjects was 12 months (interquartile range 3.5-33.4 mo) and 16.6, 6.0 and 2.9 months for local, re-gional, and distant disease, respectively. Survival benefit was seen with TACE (P < .001) and ethanol injection (P = .005). When compared with the SEER population, VA subjects had more local disease at diagnosis (74.4% vs 41.3%, P < .0001) and received more loco-regional therapy (32.4% vs 22.6 %, P < .0001).
Conclusions: Veterans with HCC are diagnosed at earlier stages and receive more loco-regional therapy compared with nonveteran subjects with HCC.
