The socioeconomic environment and access to care affect the survival of patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

BACKGROUND: The socioeconomic environment and access to care may influence the prognosis of patients with primary liver cancer. We aimed to study the effects of the socioeconomic environment and access to care on the net survival of patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (iCCA). METHODS: All patients with HCC or iCCA who were diagnosed between 2013 and 2015 within the French network of cancer registries were included, with follow-up until June 2018. The socioeconomic environment and access to care were assessed using the European Deprivation Index and the Spatial Accessibility Multiscalar (SCALe) index. The excess hazard ratios (EHR) were estimated and modelled using flexible parametric survival models with multidimensional penalized splines. RESULTS: In total, 6137 patients were included (4931 with HCC and 1206 with iCCA). The 5-year net survival rates for men and women with HCC were 19.7% (95% confidence interval (CI) [18.1; 21.3]) and 20.0% (95% CI [16.2; 24.1]), respectively, and the 5-year net survival rates for men and women with iCCA were 10.4% (95% CI [7.5;14.0]) and 10.3% (95% CI [7.4;13.8]), respectively. A socioeconomic gradient was identified between the most and the least deprived areas for men with HCC (EHR 1.16 (95% CI [1.04;1.29]). Difficult access to care negatively affected the net survival of women with HCC (EHR 1.36 (95% CI [1.10;1.68]) corresponding to the 3rd quintile of distribution) and women with iCCA (EHR 1.37 (95% CI [1.07;1.76]) for the most isolated quintile compared with the least isolated quintile). CONCLUSIONS: This study provides distinct net survival analyses for patients with HCC and iCCA. The net survival of patients with HCC is twice as high as that of patients with iCCA. The social environment adversely affects the net survival of men with HCC, whereas the geographical environment adversely affects that of women with HCC and iCCA.