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

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• 作者：Stephen H. Gray ; MD^a ; ^{sgray@uabmc.edu} ; Jared A. White ; MD^a ; Peng Li ; PhD^d ; Meredith L. Kilgore ; PhD^d ; David T. Redden ; PhD^d ; Ahmed K. Abdel Aal ; MD ; PhD^b ; Heather N. Simpson ; MD^c ; Brendan McGuire ; MD^c ; Devin E. Eckhoff ; MD^a ; Derek A. Dubay ; MD^e
• 关键词：CI ; confidence interval ; HCC ; hepatocellular carcinoma ; HR ; hazard ratio ; SEER ; Surveillance ; Epidemiology ; and End Results [database]
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：28
• 期：2
• 页码：231-237.e2
• 全文大小：627 K
• 卷排序：28

文摘

To measure transarterial chemoembolization utilization and survival benefit among patients with hepatocellular carcinoma (HCC) in the Surveillance, Epidemiology, and End Results (SEER) patient population.Materials and MethodsA retrospective study identified 37,832 patients with HCC diagnosed between 1991 and 2011. Survival was estimated by Kaplan–Meier method and compared by log-rank test. Propensity-score matching was used to address an imbalance of covariates.ResultsMore than 75% of patients with HCC did not receive any HCC-directed treatment. Transarterial chemoembolization was the most common initial therapy (15.9%). Factors associated with the use of chemoembolization included younger age, more HCC risk factors, more comorbidities, higher socioeconomic status, intrahepatic tumor, unifocal tumor, vascular invasion, and smaller tumor size (all P < .001). Median survival was improved in patients treated with chemoembolization compared with those not treated with chemoembolization (20.1 vs 4.3 mo; P < .0001). Similar findings were demonstrated in propensity-scoring analysis (14.5 vs 4.2 mo; P < .0001) and immortal time bias sensitivity analysis (9.5 vs 3.6 mo; P < .0001). There was a significantly improved survival hazard ratio (HR) in patients treated with chemoembolization (HR, 0.42; 95% confidence interval, 0.39–0.45).ConclusionsPatients with HCC treated with transarterial chemoembolization experienced a significant survival advantage compared with those not treated with transarterial chemoembolization. More than 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 transarterial chemoembolization.