Transarterial Radioembolization Versus Systemic Treatment for Hepatocellular Carcinoma with Macrovascular Invasion: Analysis of the U.S. National Cancer Database

Abstract

Systemic therapy remains the recommended first-line treatment for hepatocellular carcinoma (HCC) with macrovascular invasion (MVI). Transarterial radioembolization (TARE) is a promising alternative treatment, given its potential to impart a superior quality of life. The aims of this study were, first, to characterize trends and correlates for TARE as a first-line treatment for HCC patients with MVI in the United States and, second, to compare survival after TARE versus systemic therapy. Methods: We used the U.S. National Cancer Database to identify patients with T3BN0M0 HCC during 2010-2017. We performed multivariable logistic regression to identify factors associated with use of TARE versus systemic therapy and Cox proportional-hazards regression to identify factors associated with overall survival. Results: Of 11,259 patients with T3BN0M0 HCC, 1,454 (12.9%) and 3,915 (34.7%) were treated with TARE and systemic therapy, respectively. The proportion of patients who received TARE increased from 13.0% in 2010 to 37.0% in 2017. Older age, white race, and receiving care at an academic cancer program were associated with receipt of TARE, whereas lack of insurance, higher model-for-end-stage-liver-disease score, Charlson comorbidity index of at least 3, and Northeast region were associated with receipt of systemic therapy. TARE was associated with reduced mortality compared with systemic therapy (adjusted hazard ratio, 0.74; 95% CI, 0.68-0.80), with consistent results observed in propensity-weighted analysis and across all examined subgroups. Conclusion: Use of TARE as first-line therapy for HCC with MVI has increased in the United States. Patient characteristics, region, and medical center type affected the use of TARE. TARE was associated with reduced mortality compared with systemic therapy for HCC patients with MVI.