P4625 - Associations Between Liver Disease Etiology and Post-Liver Directed Treatment Mortality in HCC

Chidi Iloabachie, BS¹, Yue Jiang, PhD², Sydney Power, MD³, Arjun Juneja, BS⁴, Merete Lund, MD³, Gabe Lupu, MD³, Joyce Badal, MD⁴, David Seligson, MS⁵, Hanna Sanoff, MD³, David Mauro, MD³, David Gerber, MD⁴, Ted Yanagihara, MD³, Alfred S. Barritt, MD, MSCR⁶, Andrew Moon, MD, MPH^3
1University of North Carolina at Chapel Hill School of Medicine, Carrboro, NC; ²Duke University, Chapel Hill, NC; ³University of North Carolina, Chapel Hill, NC; ⁴University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ⁵Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC; ⁶UNC, Chapel Hill, NC

Introduction: Hepatocellular carcinoma (HCC) is the most common cancer in patients with chronic liver disease and cirrhosis. Most patients with HCC receive one or more locoregional therapies (thermal ablation, transarterial chemo- or radioembolization, external beam radiation). The underlying liver diseases leading to HCC are changing rapidly with the advent of effective medications for hepatitis C virus (HCV) and hepatitis B virus (HBV) and the rising burden of obesity, diabetes, and unhealthy alcohol use. The degree to which liver disease etiology influences outcomes after locoregional therapies for HCC is uncertain. This study aimed to assess if the etiology of HCC is associated with mortality post-liver-directed therapy.

Methods: We performed a single-center retrospective analysis of adults with HCC treated with liver-directed locoregional therapies from 4/4/2014 to 12/31/2021. Baseline sociodemographic and clinical characteristics were extracted. The primary outcome was time to death after initial treatment. Etiologies of HCC were categorized as alcohol-associated (ALD), metabolic dysfunction-associated (MASLD), viral (HBV/HCV), and other. Patients with contributions from more than one of these categories were classified as multiple. Mortality was determined via linkage to state death databases with confirmation by chart review. We performed unadjusted and multivariable proportional hazards regression to assess potential associations between etiology and mortality, adjusting for potential confounders.

Results: This study included 338 patients with HCC with the following initial treatments: 76 laparoscopic ablations, 60 percutaneous ablations, 12 bland embolizations, 137 TACE, 29 TARE/Y90, and 24 SBRT. The most common etiologies among patients with only a single etiology were viral (N = 134; 40%) and MASLD (N = 52; 15%). 86 patients had multiple etiologies (25%). Patients with alcohol-associated etiology were more likely to receive curative treatment. In both the unadjusted and multivariable model adjusting for age, sex, Charlson comorbidity score, Child-Pugh score, ECOG PS, BCLC stage, and treatment type, we did not find an association between etiology and mortality post-treatment.

Discussion: In this retrospective study, liver disease etiology was not significantly associated with mortality. While larger multicenter trials may help further inform this question, data from this study suggests that etiology may not inform prognosis for non-metastatic HCC.



Disclosures:


Chidi Iloabachie, BS¹, Yue Jiang, PhD², Sydney Power, MD³, Arjun Juneja, BS⁴, Merete Lund, MD³, Gabe Lupu, MD³, Joyce Badal, MD⁴, David Seligson, MS⁵, Hanna Sanoff, MD³, David Mauro, MD³, David Gerber, MD⁴, Ted Yanagihara, MD³, Alfred S. Barritt, MD, MSCR⁶, Andrew Moon, MD, MPH³. P4625 - Associations Between Liver Disease Etiology and Post-Liver Directed Treatment Mortality in HCC, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.