ArticleCancer medicine2023
Insurance status impacts survival of hepatocellular carcinoma patients after liver resection.
Article in Cancer medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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8 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Association of insurance status among cancer patients and survival outcomes: a systematic review and meta-analysis.International journal for equity in health · 2025Pooled it
- Diagnostic performance of diffusion-weighted imaging with quantitative apparent diffusion coefficient for detecting residual or recurrent hepatocellular carcinoma after TACE: a meta-analysis.Abdominal radiology (New York) · 2026Article
- Management and outcomes of patients with liver cancer in China and the United States.Chinese medical journal · 2026Article
- The impact of public hospital performance-based pay scheme reform on revenue structure and service efficiency under the Diagnosis-Intervention Packet payment system: evidence from a pilot city in China.BMC health services research · 2026Article
- Disparities in inpatient treatment and expenditures among lung cancer patients under tiered social health insurance: a population-based study in China.International journal for equity in health · 2025Article
- Healthcare Disparities in the Treatment and Outcomes of Hepatocellular Carcinoma in South Africa.World journal of surgery · 2025Article
- Safety of nighttime elective hepatectomy for hepatocellular carcinoma patients: a retrospective study.Annals of surgical treatment and research · 2024Article
- Insurance status impacts survival of hepatocellular carcinoma patients after liver resection.Cancer medicine · 2023Article
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Authors and funding
5 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study intends to examine the effect of public insurance status on survival outcomes of HCC patients after liver resection in China.
methodsWe divided 2911 HCC patients after liver resection included in our study into the Urban Employed-based Medical Insurance group (UEBMI group, n = 1462) and the non-Urban Employed-based Medical Insurance group (non-UEBMI group, n = 1449). A propensity score matching (PSM) analysis was used to control confounding factors. Overall survival (OS) was estimated by Kaplan-Meier curves and Cox proportional hazard models based on variables screened by Lasso regression. Competing risk analysis was used to analyze cancer-specific survival (CSS).
resultsUEBMI group had more male patients (p = 0.031), patients in the UEBMI group were older (p < 0.001) and had lower Charlson Comorbidity Index scores (CCI score, p < 0.001). Meanwhile, patients in the UEBMI group had better liver function (albumin-bilirubin grade I [ALBI I], p < 0.001) and lower tumor burden (α-fetoprotein [AFP], p = 0.009; Barcelona Clinic Liver Cancer stage [BCLC], p = 0.026; Milan criteria, p < 0.001; tumor size, p < 0.001; microvascular invasion [MVI], p = 0.030; portal vein tumor thrombosis [PVTT], p = 0.002). More patients in the UEBMI group received laparoscopic surgery (p = 0.024) and adjuvant transarterial chemoembolization (TACE, p < 0.001). After PSM, patients in the two matched groups had similar characteristics. Patients with recurrent HCC in the UEBMI were more likely to receive curative therapy (p < 0.001) and less likely to receive supportive care (p < 0.001). HCC patients after liver resection in the non-UEBMI group had a worse OS before (p < 0.0001) and after PSM (p = 0.002). [Correction added on August 16, 2023 after first online publication. The p value has been updated in the preceding sentence.] In our Lasso-Cox risk regression model, public health insurance status was an independent factor linked with OS (non-UEBMI vs. UEBMI, hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12-1.46; p < 0.001). In the competing risk analysis, patients in the UEBMI group had a lower cumulative incidence of CSS before (p < 0.001) and after PSM (p = 0.001), and public insurance status of HCC patients after liver resection remained independently associated with CSS (non-UEBMI vs. UEBMI; HR:1.36; 95% CI: 1.18-1.58; p < 0.001).
conclusionsUnderinsured HCC patients after liver resection had worse survival outcomes. Less access to care for underinsured patients may explain the difference in survival, but the corresponding conclusions need to be further explored.
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