562 - Impact of Etiology, Age, and Race/Ethnicity on Outcomes Following Transarterial Locoregional Therapy for Hepatocellular Carcinoma: A Multi-Institutional Cohort Study

Purpose: To evaluate real-world outcomes of first-line transarterial therapy in hepatocellular carcinoma (HCC) and determine whether progression and curative therapy rates differ across patient subgroups defined by liver disease etiology, age, and race/ethnicity.

Materials and Methods: We conducted a retrospective cohort study using the TriNetX database, identifying adults with HCC who received bland embolization (TAE), chemoembolization (TACE), or radioembolization (TARE) as first-line treatment between 2000–2023. Patients with prior liver-directed or systemic therapies or those with extrahepatic spread at baseline were excluded. Subgroups were stratified by etiology (Hepatitis C virus [HCV], metabolic–associated steatotic liver disease [MASLD], alcohol-related liver disease [ALD]), age (< 65 vs ≥65 years), and race/ethnicity (White, Black, Hispanic). Propensity-score matching balanced baseline characteristics between subgroups. The primary outcome was progression, a composite of death, additional therapy, or extrahepatic metastases. The secondary outcome was receipt of curative therapy (resection or liver transplantation [LT]). Risk ratios (RR) assessed outcome incidence; Kaplan-Meier analysis was used for progression-free survival (PFS) and time to curative therapy (TTC).

Results: Among 5,060 patients (mean age 65 years; 76.1% male) who received first-line transarterial therapy, 46.1% experienced HCC progression by 24 months, including 22.6% who required additional therapy and 10.2% who developed extrahepatic metastases. Curative therapy was achieved in 11.9% of patients, most commonly LT (10.1%). Median PFS was 540 days, with survival rates of 71%, 57%, and 45% at 6, 12, and 24 months, respectively. After matching, older adults had prolonged TTC (p< 0.001) while younger patients more often received additional treatment (RR: 1.14, p=0.035). Hispanic patients exhibited better PFS (p=0.005) and lower rates of retreatment (RR: 0.70, p=0.003), but they experienced prolonged TTC (p< 0.001) compared with White patients. Black and White patients had comparable outcomes.

Conclusion: First-line transarterial therapy for HCC achieved a median PFS of 18 months, with curative therapy attained in 12% of patients. Outcomes were consistent across etiologies but varied by age and race/ethnicity, underscoring the need for personalized surveillance and treatment strategies while supporting the broad utility of transarterial therapy in diverse HCC populations.