Nationwide Trends and the Influence of Age and Gender in the In-Patient Care of Patients with Hepatocellular Carcinoma in Germany between 2010 and 2020

• Published in: Cancers 2023-05, Vol.15 (10), p.2792
• Main Authors: Decker, Josua A, Scheurig-Muenkler, Christian, Luitjens, Jan H, Kroencke, Thomas
• Format: Article
• Language: English
• Subjects: Ablation; Age; Analysis; Care and treatment; Comorbidity; Coronaviruses; COVID-19; Gender; Health aspects; Hepatocellular carcinoma; Hepatoma; Hospitalization; Invasiveness; Liver; Liver cancer; Liver diseases; Medical care, Cost of; Mortality; Pandemics; Patients; Regression analysis; Reimbursement; Statistics; Surgery; Trends
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15102792

This study analyzes nationwide trends in HCC hospitalizations focusing on interventional liver-directed treatments and the influence of age and gender. Using data from the German Federal Statistical Office all hospitalizations for HCC between 2010 and 2020 were included. Uni- and multivariable logistic regression analyses were performed to identify variables independently associated with the use of liver-directed therapies. Due to the COVID-19 pandemic, data from 2020 were analyzed separately. A total of 134,713 hospitalizations (2010-2019) were included, increasing by 3.4% annually (12,707 to 13,143). The mean in-hospital stay (-15.0% [7.2 to 6.1 days]) and mortality (-23.2% [6.8 to 5.2%]) decreased while transarterial, surgical, and percutaneous ablative interventions increased by 38.6, 31.5, and 19.3%, respectively. In-hospital mortality was 7.7% in admissions with surgical treatment, while it was 0.6 and 0.5% for transarterial and percutaneous interventions. Mortality was higher in females (6.2 vs. 5.7%). Females (OR 0.89 [0.86,0.91], 0.001) and patients ≥80 years (OR 0.81 [0.79,0.84], 0.001) were less likely to receive liver-directed treatments. Liver-directed therapies were increasingly performed while in-hospital mortality and in-hospital stay decreased. Minimally invasive approaches showed lower mortality, shorter in-hospital stay, and lower costs compared to surgery. Proportionately, more women and older patients were hospitalized, receiving fewer liver-directed treatments while their mortality was higher.