Duke University Medical Center, Durham, NC
Michael Morse , Anne-Marie Meyer , Marcus Lawrance , Marta Pereira , Shivani K. Mhatre , Vincent Gaillard , Farshid Dayyani
Background: Outcomes in pts with hepatocellular carcinoma (HCC) vary by epidemiology, degree of hepatic dysfunction and tx. We analyzed the relationship between tx patterns and outcomes to help characterize emerging clinical data in the context of contemporary disease management. Methods: Retrospective observational study of the Flatiron Health de-identified electronic health record–derived database to analyze the relationship between first recorded tx (1tx) and overall survival (OS) in pts diagnosed with HCC (any stage) Jan 2011 to Nov 2018. Tx categories included transplant, resection/SBRT/RFA, TACE/TARE/TAE, tyrosine kinase inhibitor (TKI), cancer immunotherapy (CIT), and others. Descriptive statistics were used to summarize tx distribution and pt characteristics; Kaplan-Meier method was used to estimate OS by tx category. Results: A total of 2134 pts with HCC were categorized by 1tx: transplant (n = 35), resection/SBRT/RFA (n = 408), TACE/TARE/TAE (n = 830), TKI (n = 751), and CIT (n = 20). Pt demographics were generally similar across txs (Table). Overall, pts with HCC had a median OS of 16.6 mo; varying from 71.5 mo in pts receiving transplant to 5.0 mo in pts treated with TKI. Conclusions: Pts receiving systemic tx for HCC have poor prognoses in clinical practice. Despite the limitations of data availability, this study showed a substantial unmet need for more effective HCC tx options.
All Treatments N = 2134 | Transplant n = 35 | Resection/ SBRT/RFA n = 408 | TACE/TARE/TAE n = 830 | TKI n = 751 |
CIT n = 20 |
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Age, mean (SD), y | 66.1 (9.5) | 59.3 (6.8) | 65.9 (10.2) | 66.0 (9.1) | 66.5 (9.3) | 67.0 (7.5) |
Male, n (%) | 1654 (78) | 27 (77) | 285 (70) | 655 (79) | 601 (80) | 16 (80) |
Community practice, n (%) | 1654 (78) | 8 (23) | 292 (72) | 574 (69) | 698 (93) | 17 (85) |
Diagnosis year ≥2017, n (%) | 623 (29) | 7 (20) | 108 (26) | 242 (29) | 217 (29) | 18 (90) |
Hepatitis C, n (%) | 966 (45) | 23 (66) | 171 (42) | 407 (49) | 322 (43) | 8 (40) |
Hypoalbuminemia ( < 3.5 g/dL), n (%)a | 548 (43) | 14 (67) | 38 (23) | 178 (40) | 295 (52) | 9 (47) |
Abnormal bilirubin ( < 0.3 or > 1.2 mg/dL), n (%)a | 482 (35) | 26 (96) | 47 (23) | 145 (29) | 229 (41) | 9 (47) |
Median OS (95% CI), mo | 16.6 (15.1, 19.2) | 71.5 (55.9, NE) | 47.0 (38.7, 58.3) | 25.4 (23.1, 28.9) | 5.0 (4.5, 6.1) | 6.7 (1.1, NE) |
a% of pts with known lab values (≈60% of total N, varies by lab).
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