Comparing Demographic Factors and Outcomes in Hepatocellular Carcinoma Treatment: Evaluation of Y90 Radioembolization versus Combined TACE plus MWA

Monday, March 31, 2025

3:00 PM – 3:09 PM CT

Location: Music City Center, 209 ABC

Presenting Author(s)

Ibukunoluwa Ibrahim (he/him/his)

Medical Student
University of California, San Francisco, United States

Author/Co-author(s)

Shin Mei Chan, MD

Resident Physician
University of California, San Francisco, United States
BK

Bridget F. Kilbride, BS

Research and Development Engineer
University of California, San Francisco, United States
Parmede Vakil, MD, PhD

Resident
UCSF, United States
OH

Omar Hassan, MD

Assistant Professor
University of California, San Francisco, United States
SH

Sina Houshmand, MD

Assistant Professor
University of California, San Francisco, United States
DG

David V. Glidden, PhD, MS

Professor, Epidemiology & Biostatistics
University of California, San Francisco, United States
NF

Nicholas Fidelman, MD

Professor
University Of California San Francisco, United States
R. Peter Lokken, MD, MPH, FSIR (he/him/his)

Associate Professor of Clinical Radiology
UCSF Department of Radiology and Biomedical Imaging, United States
Vishal Kumar, MD

Associate Professor
University of California, San Francisco, United States
Christopher Brunson, MD

Assistant Professor
University of California, San Francisco, United States

Purpose:
Socioeconomic factors may impact locoregional therapy (LRT) for hepatocellular carcinoma (HCC). Combined chemoembolization (TACE) with microwave ablation (MWA) may be an acceptable alternative to trans-arterial radioembolization (TARE) in underserved settings due to easier accessibility. The aim of this study was to identify socioeconomic factors impacting LRT for HCC by comparing long-term outcomes between TARE and combined TACE/MWA in HCC patients, with an emphasis on disparities across socioeconomics groups.

Materials and Methods: A retrospective analysis of patients with LIRADS-5 lesions or biopsy proven-HCC treated with TARE at an academic tertiary care center or TACE/MWA at a safety net hospital within the same city was conducted. 117 patients were included (89 received TARE; 28 received TACE/MWA). For TACE/MWA the female to male ratio was 7:21 with a median age of 65 (range 48 – 77). For TARE the female to male ratio was 28:61 with a median age of 66 (range 43 – 87) . All TARE patients underwent radiation segmentectomy. Demographics (insurance type, sex, race/ethnicity) and HCC etiology were recorded. Overall survival (OS) and progression free survival (PFS) were estimated using Kaplan-Meier methods. Log-rank analysis was used to identify demographic variables associated with progression and survival. Fisher’s exact test was used to compare demographic variables.

Results: There was no significant difference in median index tumor size (2.9 cm vs 2.4 cm, P=0.08). 27% of TARE patients and 19% of TACE/MWA had multifocal disease. White patients were most likely to receive TARE (55% vs 21%, P< 0.01). Asian patients were most likely to receive TACE/MWA (39% vs 17%, P< 0.01). Insurance type was significantly different between the cohorts (P< 0.0001); patients receiving TARE more likely to have commercial insurance. Age, race, and sex were not predictors for OS nor PFS for either therapy. Etiology of HCC and insurance type were predictors for OS (P< 0.0001 and P< 0.0001, respectively) and PFS (P< 0.04 and P< 0.0001, respectively). There was no difference in unadjusted OS between TARE vs. TACE/MWA (HR=1.19, P=0.65). Difference in PFS was borderline significant between TARE and TACE/MWA when unadjusted (HR= 0.57, P=0.06), but not after adjustment for age, race, insurance and cause (HR=0.77, P=0.51).

Conclusion: Disparities in the receipt of LRT received are evident based on race/ethnicity and insurance type. While OS and PFS were not significantly different between TARE and TACE/MWA, etiology and insurance type were key, significant predictors of both overall and progression free survival.