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Thursday, August 9, 2018

Radioembolization for Hepatocellular Carcinoma: A Nationwide 10-year experience 


Summary


This retrospective study evaluated the use and outcomes of Transarterial radioembolization (TARE) for HCC over the span of 10 years in the United States. The authors utilized the National Cancer Data base (NCDB) and identified patients between 2003-2012 with HCC that were treated with TARE. Patients that underwent resection or transplantation were removed; ultimately 1222 were included in this study. The authors evaluated demographics, insurance, socioeconomic status, tumor stage, tumor size, and hospital setting. Univariable and multivariable analyses were performed, and overall survival was estimated using log-rank test. The authors found that over the study period the number of HCC diagnoses and TARE treatments increased five times. Overall survival was 13.3 months, and did not change during the study period. Survival was not influenced by age or whether the procedure was done in an academic or community hospital, however female patients demonstrated improved survival, African American patients showed the lowest median survival, and patients with a higher socioeconomical and private insurance status trended towards improved survival. Survival was improved with tumors smaller than 5 cm, and decreased with increasing AJCC stage. Multivarite analyses showed that sex, tumor size, distance from hospital, insurance status and AJCC stage correlated with overall survival. In this cohort the median survival for patients with extrahepatic disease was 7.8 months, similar to the placebo group in the SHARP trial, therefore the authors suggest that the use of TARE in extrahepatic disease patients should be extensively discussed in a multidisciplinary manner before proceeding. Sex correlated with an improved prognosis however age was not a factor; therefore as long as elderly patients show a good functional status, outcomes will remain similar to their younger counter parts. After multivariate analyses African American patients showed a trend towards worse prognosis when compared to white patients. The authors found that this study is limited by the retrospective design, the use of the NCDB database, and the lack of cost analyses associated with TARE. Ultimately this study concluded that male sex, tumor size and extrahepatic HCC disease was associated with decreased overall survival after TARE treatment. However age alone, is not associated with a worse outcome.




Figure- Use of radioembolization in patients with HCC during the period 2003–2012.

Commentary


The findings of this study identify some prognostic factors that might influence the overall survival in HCC patients being treated with TARE. In the current environment where HCC can be treated with surgery, transplantation, catheter directed therapies (TAE, TACE, TARE), ablations, and systemic therapy, it is important to identify which patients will benefit the most from TARE therapy. The use of the NCDB database provides strength to this study since a large number of patients are included. Patients had various demographic characteristics, presented either to academic or community hospitals, possessed different types of insurance, belonged to different socioeconomic groups, and presented with different tumor sizes and tumor stages. Therefore this analysis evaluates many variables that are encountered in every day practice. The results in this study highlight that age of presentation is not as important as sex, AJCC stage, tumor size and insurance type. More studies are necessary to identify which HCC patients benefit the most from TARE treatment.

Click here for abstract

Tohme S, Bou Samra P, Kaltenmeier C, Chidi AP, Varley PR, Tsung A. Radioembolization for Hepatocellular Carcinoma: A Nationwide 10-Year Experience. J Vasc Interv Radiol. 2018; 29(7):912-919.

Post Author: 
Carlos J. Guevara, MD
Assistant Professor
Department of Radiology, Interventional Radiology Division
University of Texas Health Sciences, Houston
@UTHouston_IR

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