571 - Can Hospital Volume of TARE Affect Survival in Early-stage HCC ?

Purpose: Procedural volume is an independent predictor of outcomes in surgical procedures. However, the effect of Y-90 trans arterial radioembolization (TARE) procedural volume as a predictor of mortality in patients with hepatocellular carcinoma (HCC) is yet unexplored.

Materials and Methods: The National Cancer Database was queried for the years 2018–2024 to identify patients who underwent TARE as primary/first treatment for HCC (C22.0). Only patients with American Joint Committee on Cancer (AJCC) Stage I disease were included. The primary outcome was overall survival. Propensity score matched cohorts were created to assess the effect of facility volume on overall survival. Nearest neighbor matching was used in a 1:1 ratio with a caliper of 0.2. Matching was performed using the following covariates: age, sex, AFP level, INR, creatinine, fibrosis score, race, insurance status, bilirubin, household income, and Charlson–Deyo comorbidity score . Hospitals were categorized at the 95% percentile cutoff point into low-volume (< 11 TARE procedures/year) or high-volume (≥11 TARE procedures/year) .

Results: A total of 2,337 patients met inclusion criteria and were treated with TARE. The mean age was 69 years (SD 9), and 72% were male. Among them, 1,345 patients were treated at high-volume centers (≥11 cases/year) and 984 at low-volume centers (< 11 cases/year). After 1:1 propensity score matching (PSM), 1,434 patients remained (717 per group). Median survival for the entire cohort was 37 months (95% CI: 36–38). After matching, treatment at high-volume centers was independently associated with improved overall survival compared with low-volume centers (HR 0.85, 95% CI 0.73–0.97, p=0.019). Median overall survival was 34.8 months (95% CI: 32.4–38.2) at low-volume centers versus 38.9 months (95% CI: 37.1–41.3) at high-volume centers. Kaplan–Meier analysis demonstrated significantly improved survival for patients treated at high-volume centers (p=0.013).

Conclusion: In patients with early-stage hepatocellular carcinoma undergoing trans arterial radioembolization, treatment at high-volume centers (≥11 procedures/year) is independently associated with improved overall survival compared with low-volume centers.