Factors Associated with Primary Liver Cancer Survival in a Southern Italian Setting in a Changing Epidemiological Scenario
Sergio Mazzola (Azienda Ospedaliera Universitaria Policlinico di Palermo)
Martina Vittorietti (TU Delft - Statistics)
Santo Fruscione (University of Palermo)
Daniele Domenico De Bella (University of Palermo)
Alessandra Savatteri (University of Palermo)
Miriam Belluzzo (University of Palermo)
Daniela Ginevra (University of Palermo)
Alice Gioia (University of Palermo)
Davide Costanza (University of Palermo)
Maria Domenica Castellone (IEOS)
Claudio Costantino (University of Palermo, Azienda Ospedaliera Universitaria Policlinico di Palermo)
Maurizio Zarcone (Azienda Ospedaliera Universitaria Policlinico di Palermo)
Barbara Ravazzolo (Azienda Ospedaliera Universitaria Policlinico di Palermo)
Giorgio Graziano (Azienda Ospedaliera Universitaria Policlinico di Palermo)
Rita Mannino (Azienda Ospedaliera Universitaria Policlinico di Palermo)
Rosalba Amodio (Azienda Ospedaliera Universitaria Policlinico di Palermo)
Vito Di Marco (University of Palermo)
Francesco Vitale (Azienda Ospedaliera Universitaria Policlinico di Palermo, University of Palermo)
Walter Mazzucco (Azienda Ospedaliera Universitaria Policlinico di Palermo, University of Palermo, University of Cincinnati)
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Abstract
A retrospective observational study utilising cancer incidence data from a population-based registry investigated determinants affecting primary liver cancer survival in a southern Italian region with high hepatitis viral infection rates and obesity prevalence. Among 2687 patients diagnosed between 2006 and 2019 (65.3% male), a flexible hazard-based regression model revealed factors influencing 5-year survival rates. High deprivation levels [HR = 1.41 (95%CI = 1.15–1.76); p < 0.001], poor access to care [HR = 1.99 (95%IC = 1.70–2.35); p < 0.0001], age between 65 and 75 [HR = 1.48 (95%IC = 1.09–2.01); p < 0.05] or >75 [HR = 2.21 (95%CI = 1.62–3.01); p < 0.0001] and residing in non-urban areas [HR = 1.35 (95%CI = 1.08–1.69); p < 0.01] were associated with poorer survival estimates. While deprivation appeared to be a risk factor for primary liver cancer patients residing within the urban area, the geographic distance from specialised treatment centres emerged as a potential determinant of lower survival estimates for residents in the non-urban areas. After balancing the groups of easy and poor access to care using a propensity score approach, poor access to care and a lower socioeconomic status resulted in potentially having a negative impact on primary liver cancer survival, particularly among urban residents. We emphasise the need to interoperate cancer registries with other data sources and to deploy innovative digital solutions to improve cancer prevention.
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