Survival outcomes of patients with unresectable hepatocellular carcinoma in a national population-based study: SEER versus tertiary cancer center.

Abstract

e14736 Background: To evaluate long-term survival in patients with unresectable hepatocellular carcinoma (HCC) in large national population-based database and to assess the impact of subspecialized care on similarly matched patients at a tertiary cancer center. Methods: Using the Surveillance, Epidemiology and End Results (SEER) registry, patients diagnosed between 2004 and 2008 with advanced unresectable HCC not amendable to radiation therapy or cancer-directed surgery were extracted. Additionally, similar matched patients receiving drug eluting bead transarterial chemoembolizaton (DEB TACE) for unresectable HCC were included in the study. Demographic, clinical, and procedural data were collected. Patients were stratified based on Contract Health Service Delivery Areas (CHSDA) and the rural- urban continuum. The Kaplan Meier method was used for survival analysis, and survival curves were compared using the log rank test in SPSS. Results: 14,369 patients were studied and demographics were as follows: mean age at time of diagnosis was 63.97 years (SD 12.5); 76.1% were male; 66.7% were Caucasian; 13.3% were African-American; and 19.4% were Asian or American Indian. The overall median observed survival from diagnosis of the 136 patients receiving DEB TACE was significantly higher when compared to the 404 Atlanta patients and the 12,012 SEER patients (median OS = 22 vs 4 vs 4 months respectively, p< 0.05). When compared to CHSDA, the median overall survival for patients receiving DEB TACE was 5 times longer than all other geographical areas (22 months vs 3, 4, 3, 4, and 4 in Alaska, East, Northern Plains, Pacific Coast, and the Southwest, respectively, p<0.05). Metropolitan, urban, and rural areas demonstrated similar survival outcomes and patients receiving DEB TACE had superior survival (22 vs 3-4 months, p<0.05). Conclusions: This study suggests that DEB TACE is viable treatment option that confers significantly beneficial survival results when compared to similar patients nationwide diagnosed with advanced unresectable HCC in the same 5-year time frame regardless of population demographics and health service delivery area.