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

Academic Article


  • PURPOSE: 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 METHODS: A 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. RESULTS: More 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). CONCLUSIONS: Patients 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.
  • Keywords

  • Aged, Aged, 80 and over, Carcinoma, Hepatocellular, Chemoembolization, Therapeutic, Chi-Square Distribution, Female, Humans, Kaplan-Meier Estimate, Liver Neoplasms, Logistic Models, Male, Medicare, Patient Selection, Practice Patterns, Physicians', Propensity Score, Proportional Hazards Models, Retrospective Studies, Risk Factors, SEER Program, Time Factors, Treatment Outcome, United States
  • Digital Object Identifier (doi)

    Author List

  • Gray SH; White JA; Li P; Kilgore ML; Redden DT; Abdel Aal AK; Simpson HN; McGuire B; Eckhoff DE; Dubay DA
  • Start Page

  • 231
  • End Page

  • 237.e2
  • Volume

  • 28
  • Issue

  • 2