A SEER Database Analysis of the Survival Advantage of Transarterial Chemoembolization for Hepatocellular Carcinoma: An Underutilized Therapy

Abstract

Purpose To measure TACE utilization and survival benefit among patients with HCC in the SEER patient population. Method and Methods A retrospective study identified 37, 832 patients with HCC diagnosed between 1991 and 2011. Survival was estimated by Kaplan-Meier method and compared using the log rank test. Propensity score matching was used to address imbalance of covariates. Results Over 75% of HCC patients did not receive any HCC directed treatment. TACE was the most common initial therapy (15.9%). Factors associated with TACE utilization included younger age, more HCC risk factors, more comorbidities, higher socio-economic status, intrahepatic tumor, unifocal tumor, vascular invasion, and smaller tumor size (all p<0.001). Median survival was improved in patients treated with TACE compared to those not treated with TACE (20.1 vs. 4.3 months, p<0.0001). Similar findings were demonstrated in propensity scoring analysis (14.5 vs. 4.2 months, p<0.0001) and immortal time bias sensitivity analysis (9.5 vs. 3.6 months, p<0.0001). There was a significantly improved survival hazard ratio in patients treated with TACE [HR 0.42 (95%CI 0.39 – 0.45)]. Conclusions HCC patients treated with TACE experienced significant survival advantage compared to those not treated with TACE. Over 75% of SEER-Medicare patients diagnosed with HCC received no identifiable oncologic treatment. There is a significant public health need to increase awareness of efficacious HCC treatments such as TACE.

Trends in hepatocellular carcinoma research from 2008 to 2017: a bibliometric analysis

“…In the United States, TACE is not only the most common therapy for HCC patients but also the most common bridging therapy for patients waitlisted for liver transplantation ( Shah et al, 2011 ; Thuluvath et al, 2010 ). According to a retrospective study of the SEER database, TACE utilization significantly improved survival for HCC patients, especially those at an intermediate stage ( Gray et al, 2017 ). Additionally, a recent study has proved that TACE can be a useful treatment option for HCC patients with segmental portal vein tumour thrombus ( Choi et al, 2017 ).…”

Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages

“…The TACE treatment rationale is that the intraarterial infusion of cytotoxic agents followed by tumor‐feeding blood vessel embolization induces strong cytotoxic and ischemic effects in tumors. Database analyses in other countries also reported that TACE was the most frequently selected first‐line treatment …”

Rethinking the Role of Radiation Therapy in the Treatment of Unresectable Hepatocellular Carcinoma: A Data Driven Treatment Algorithm for Optimizing Outcomes

“…TACE is a commonly used treatment modality in patients with HCC who are deemed poor candidates for curative treatment with surgery or RFA. According to a recent Surveillance, Epidemiology, and End Results (SEER) database analysis, TACE is the most common initial therapy utilized in the US (64%) among patients who receive treatment for HCC (17). This treatment involves the intra-arterial injection of chemotherapeutic agents followed by obstruction of selective hepatic arterial inflow with embolizing particles.…”