Improved hepatocellular carcinoma (HCC) outcomes in a public hospital setting with increased access to procedural-based therapy.

Abstract

e18137 Background: HCC is the 2nd most common cause of cancer death in the world. We investigate if increased access to various treatment modalities improved outcomes in a public hospital setting. Access to procedural-based treatments improved with development of an in hospital interventional radiology program that resulted from increased public hospital funding starting in 2013 at University Medical Center in New Orleans (UMC). Methods: A retrospective chart review was conducted to analyze 124 patients (pts) diagnosed with HCC from 2013 to 2018 at UMC to determine effect of treatment modality on outcome. Comparative analysis and Fisher’s exact test was performed using a previous study analyzing a similar population (n = 107) from 2007-2013. Results: Pts with HCC treated with transarterial chemoembolization (TACE) had an overall survival (OS) of 82.55% and 54.84% at 1 and 3 years (yr). Pts not treated with TACE had OS of 60.69% and 38.49% at 1 and 3 yr. OS in the 2007-2013 cohort at 1 year was 29%. Progression free survival (PFS) in pts treated with TACE was 52.99% and 22.66% at 1 and 3 yr. PFS in patients not treated with TACE was 58.36% and 50.28% at 1 and 3 yr. Treatment with Sorafenib (S) with or without TACE had OS of 75.84% and 48.43% at 1 and 3 yr. Pts not receiving S had an OS of 69.17% and 48.47% at 1 and 3 yr. PFS was 37.27% and 10.57% in pts treated with S at 1 and 3 yr. PFS for pts not treated with S was 67.00% and 47.02% over 1 and 3 yr. There were 140 total IR procedures which averages to 1.13 IR procedures per pt. Compared to 2007-2013 cohort, more HCC pts had TACE (10% to 56%, p < 0.001) and received S (18% to 39%,p < 0.001). Conclusions: Although PFS was not better for those pts treated with TACE (p value = 0.218), OS was statistically better with TACE (p value = 0.003). Radiologic response rates do not appear to correlate with OS benefit, perhaps due to TACE effect on image interpretation. PFS was decreased in pts treated with S (p value = < 0.0001), possibly due to its use in pts who have progressed despite TACE. The 2013-2018 cohort has superior OS compared to the 2007-2013 cohort at 1 yr. Increased access to procedural- based, locoregional therapy and S positively impacts patient outcomes.