title: A SEER Database Analysis of the Survival Advantage of Transarterial Chemoembolization for Hepatocellular Carcinoma: An Underutilized Therapy.
abstract: OBJECTIVE
  To measure transarterial chemoembolization utilization and survival benefit among patients with hepatocellular carcinoma (HCC) in the Surveillance, Epidemiology, and End Results (SEER) patient population.
  
  
  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.
authors.affiliation: Department of Surgery, Division of Abdominal Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama. Electronic address: sgray@uabmc.edu.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gray
authors.affiliation: Department of Surgery, Division of Abdominal Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
authors.forename: Jared A
authors.initials: JA
authors.lastname: White
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.affiliation: Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
authors.forename: Ahmed K
authors.initials: AK
authors.lastname: Abdel Aal
authors.affiliation: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Simpson
authors.affiliation: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
authors.forename: Brendan
authors.initials: B
authors.lastname: McGuire
authors.affiliation: Department of Surgery, Division of Abdominal Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
authors.forename: Devin E
authors.initials: DE
authors.lastname: Eckhoff
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Dubay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D006278:Medicare; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology