3550 - Trends in Local Therapy for Hepatocellular Carcinoma from 2004-2019: An NCDB Analysis
Presenter(s)
B. L. Tran, and M. Buckstein; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
Purpose/Objective(s):
While surgical resection and radiofrequency ablation (RFA) are the standard of care for early-stage hepatocellular carcinoma (HCC), there are multiple new treatments available including stereotactic body radiation therapy (SBRT) and trans-arterial radioembolization (TARE). However, with limited randomized prospective data, the decision on which treatment to use is not always data driven and might reflect other factors. In this National Cancer Database (NCDB) analysis, we analyze the trends in utilization of several local therapies for patients with HCC from 2004 to 2019.Materials/Methods: We queried the NCDB for treated patients with HCC from 2004 to 2019, classified in TNM stage group I or II, and treated with either total hepatectomy and transplant, RFA, trans-arterial chemoembolization (TACE), TARE, or SBRT. Trend analysis using Joinpoint Regression Program (v5.3.0.0) identified time points in which trends in therapy utilization shifted and reported annual percentage changes (APC) derived from a log-linear model.
Results: A total of 77,704 patients matching our query were identified with Stage I or II disease—with 53% treated with TACE, 22% with RFA, 13% with total hepatectomy and transplant, 9.4% with TARE, and 2.9% with SBRT as first treatment. Joinpoint regression results are summarized in the table below.
Since 2004, total hepatectomy and transplant had initially trended positive, but declined since 2014 (-6.89%). TACE increased in utilization from 2004 to 2009 (35.5%) followed by deceleration and then decline in utilization following 2015 (-9.45%). RFA has shown a positive trend since 2004 (17.6%) with a deceleration in utilization after 2015 (5.14%). Both TARE and SBRT showed fast adoption from 2004 to 2008/2009, at which point TARE utilization continued to increase with a larger APC (29% vs 19.5%) reaching an over four-fold utilization compared to SBRT by 2019 (1,673 vs 365 cases).
Conclusion: The landscape of local therapy for Stage I and II HCC has dramatically shifted from 2004 to 2019. There has been a stark decline in TACE use and a deceleration in RFA use since 2015 along with an exponential increase in TARE use since 2004 which is projected to surpass TACE. The over four-fold utilization of TARE to SBRT reflects a strong preference for this modality, despite limited data showing superiority.
a Significantly different from zero, P < 0.05
b Low case numbers skew APC Abstract 3550 - Table 1|
| Trend 1 | Trend 2 | Trend 3 | |||
| APC, % (95% CI) | Years | APC, % (95% CI) | Years | APC, % (95% CI) | Years | |
| Total hepatectomy and transplant | 20.1a (18.7, 22.0) | 2004 – 2009 | -0.73 (-2.0,1.98) | 2009 – 2014 | -6.89a (-9.11, -5.47) | 2014 – 2019 |
| TACE | 35.5a (31.1, 39.8) | 2004 – 2009 | 9.48a (6.59, 12.7) | 2009 – 2015 | -9.45a (-13.8, -5.59) | 2015 – 2019 |
| SBRT | 344ab (221, 474) | 2004 – 2006 | 61.0a (28.7, 77.0) | 2006 – 2009 | 19.5a (14.3, 22.1) | 2009 – 2019 |
| TARE | 66.8a (58.7, 72.6) | 2004 – 2008 | 29.0a (27.7, 30.2) | 2008 – 2019 | NA | |
| RFA | 17.6a (16.4, 19.1) | 2004 – 2015 | 5.14a (-3.31, 9.74) | 2015 – 2019 | ||