Survival trends in unresectable hepatocellular carcinoma and the effect of DEB-TACE: SEER versus tertiary cancer center.

Abstract

308 Background: Long-term survival in patients with advanced unresectable hepatocellular carcinoma (HCC) treated with drug-eluting bead transarterial chemoembolization (DEB-TACE) vs. best supportive care has not been investigated in large-scale population studies. Methods: Under IRB approval, our institute’s cancer registry was queried for patients with advanced unresectable HCC diagnosed from Sept 2005 to Dec 2010, treated with DEB-TACE. Eighteen registries of the U.S. Surveillance, Epidemiology and End Results (SEER) database were queried for patients with advanced HCC not amenable to surgery/radiation diagnosed in the same time period. Baseline characteristics, median overall survival (OS) from HCC diagnosis and median OS from first DEB-TACE were stratified by national/state cohorts. Survival analysis and 95% confidence intervals (CI) were calculated using Kaplan-Meier estimation. Results: A total of 231 patients who underwent DEB-TACE for unresectable HCC (Group A) and 20,897 patients with unresectable HCC who received neither radiation nor cancer-directed surgery (Group B) were included. Both groups were similar for mean age at diagnosis, gender, race, bilobar disease, portal vein thrombosis and mean largest tumor size (p>0.05). Median OS from HCC diagnosis was 21.8 months (Group A; 95% CI, 18.1-25.4) and 4.0 months (Group B; 95% CI, 3.9-4.1), p<0.001. Median OS from first DEB-TACE was 15.0 months (Group A; 95% CI, 9.6-20.4). Interval survival rates from HCC diagnosis for Group A vs. B were: 99% vs. 65% (1 month), 92% vs. 49% (3 months), 75% vs. 36% (6 months), 58% vs. 35% (1 year), 36% vs. 9% (2 years), and 20% vs. 4% (3 years). Conclusions: DEB-TACE in patients with unresectable HCC demonstrated significantly greater median OS and favorable long-term survival rates compared to best supportive care in a population-based study. [Table: see text]