Insurance Status and Hepatocellular Carcinoma Staging, Treatment and Survival: A SEER Database Analysis

Phatsimo Masire, Thomas Jefferson University


Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer mortality in the world. In the United States, there were an estimated 39,230 incident cases in 2016. Despite advances in treatment for HCC patients, many patients do not receive therapy, as high as 55% in 2010, with an overall survival rate of 16%. The purpose of this dissertation was to conduct a retrospective analysis to explore the relationship of insurance status with the stage of disease at diagnosis, initial treatment intervention, disease-specific survival, and overall survival in patients diagnosed with HCC. We conducted a retrospective cohort study using deidentified and publicly available data from the Surveillance Epidemiology and End Results Program for patients aged 18 to 64, diagnosed with HCC between the years of 2007 and 2014 (N = 25,906). Descriptive statistics were used to describe the relationship between insurance status and other demographic and clinical variables. Multinomial logistic regression analysis was performed to assess the association of insurance status with stage at diagnosis and initial treatment. Kaplan-Meier survival curves were used to describe the relationship of insurance status, stage, and treatment with both overall and HCC-specific survival. Multivariate Cox proportional hazards models were applied to analyze the association of insurance status with overall survival and HCC-specific survival. Compared to patients with localized stage, patients who were unstaged were 78% more likely to have no insurance, OR = 1.78, 95% CI [1.46, 2.17], while 71% of those with regional/distant stage, OR = 1.71, 95% CI [1.53, 1.92], were more likely to have no insurance. Compared to those who received no surgical intervention, having no insurance or Medicaid was associated with reduced odds of having surgery (OR = 0.31, 95% CI [0.24, 0.39] and OR = 0.51, 95% CI [0.46, 0.57]) and lower odds of receiving RFA (OR = 0.52, 95% CI [0.41, 0.66] and OR = 0.75, 95% CI [0.67, 0.84]). Medicaid patients and patients with no insurance had 14% higher risk, HR = 1.14, 95% CI [1.09, 1.19]) and 48% higher risk, HR = 1.48, 95% CI [1.39, 1.59], of HCC mortality during than those with private insurance at the time of diagnosis. The association with insurance status indicates that disparities exist at various levels of HCC staging, treatment, and survival.

Subject Area

Public health|Health care management|Oncology

Recommended Citation

Masire, Phatsimo, "Insurance Status and Hepatocellular Carcinoma Staging, Treatment and Survival: A SEER Database Analysis" (2018). ETD Collection for Thomas Jefferson University. AAI10845115.