studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 471A
524
Did improvement of access to healthcare change the
clinical features and long-term outcomes of hepatocellular
carcinoma in a suburban area in Japan?
Teru Kumagi 2,1 , Takahide Uehara 2 , Masaki Ohmoto 2 , Atsushi
Hiraoka 2 , Miyake Teruki 2,1 , Kazuhiro Tange 2 , Akiko Toshimori 2 ,
Norio Horiike 2 , Morikazu Onji 2 ; 1 Gastroenterology and Metabology,
Ehime University Graduate School of Medicine, To-on, Japan;
2 Saiseikai Imabari Hospital, Imabari, Japan
Background and aim: Access to healthcare is an important
factor that may affect the management of any disease. The
aim of this study is to identify the change of clinical features at
diagnosis and long-term outcomes of HCC, focusing on access
to healthcare in a suburban area in Japan. Methods: Chart
review was conducted for patients with HCC diagnosed at
a single center. Collected data (1983–2011) was analyzed
including the following data: demographics (age at diagnosis,
sex, residential postcode), Child-Pugh (CP) score, clinical stage
of HCC (TNM classification) at diagnosis, initial treatments
(resection, ablation, TACE, palliative care) and outcomes.
Patients were divided into 2 groups according to their residential
postcodes for mainland and island, in which they needed
to take ships to visit our hospital until the bridges opened in
Apr 1999. Thus the era was divided into 2 groups based
on the changes in the access pattern (former era, before Apr
1999; latter era, after Apr 1999). Local ethic board approved
the study but written consent form was waived due to the retrospective
manner. Results: Data analyses were conducted in
371 HCC patients (male 78% and 21% residing on island).
Mean age was 64.4+/-9.4. Distribution of CP scores was as
follows: A, 67%; B, 20%; and C, 13%. Distribution of clinical
stages of HCC was as follows: I, 14%; II, 35%; III, 31%; IVa,
18%; and IVb, 1.4%. Patients in the latter era (n=108) were
diagnosed at earlier stages (Stages I+II) than that in the former
era (n=263) (P=0.046). During the median observation period
of 814 days, the latter era had a significantly longer survival
rate than that of the former era (P