Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Different patterns of care and survival outcomes in transplant-centre managed patients with early−stage HCC: real−world data from an Australian multi−centre cohort study   (#428)

Jonathan Abdelmalak 1 2 3 , Simone Strasser 4 , Natalie Ngu 4 , Claude Dennis 4 , Marie Sinclair 3 , Avik Majumdar 3 , Kate Collins 3 , Katherine Bateman 3 , Anouk Dev 5 , Joshua Abasszade 5 , Zina Valaydon 6 , Daniel Saitta 6 , Kathryn Gazelakis 6 , Susan Byers 6 , Jacinta Holmes 7 8 , Alexander Thompson 7 8 , Dhivya Pandiaraja 7 , Steven Bollipo 9 , Suresh Sharma 9 , Merlyn Joseph 9 , Rohit Sawhney 10 11 , Amanda Nicoll 10 11 , Nicholas Batt 10 , Myo Tang 1 , Stephen Riordan 12 , Nicholas Hannah 13 , James Haridy 13 , Siddharth Sood 13 , Eileen Lam 2 , Elysia Greenhill 2 , Liane Ioannou 2 , John Lubel 1 2 , William Kemp 1 2 , Ammar Majeed 1 2 , John Zalcberg 1 2 , Stuart Roberts 1 2
  1. Alfred Health, Melbourne, VIC, Australia
  2. Monash University, Melbourne, VIC, Australia
  3. Gastroenterology, Austin Hospital, Melbourne, VIC, Australia
  4. AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  5. Gastroenterology, Monash Health, Melbourne, VIC, Australia
  6. Gastroenterology, Western Health, Melbourne, VIC, Australia
  7. Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
  8. Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia
  9. Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW , Australia
  10. Gastroenterology, Eastern Health, Melbourne, VIC, Australia
  11. Medicine, Eastern Health Clinical School, Melbourne, VIC, Australia
  12. Gastroenterology, Prince of Wales Hospital, Randwick, NSW, Australia
  13. Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia

Management of early−stage hepatocellular carcinoma (HCC) is complex with multiple treatment strategies available. We performed this real−world multi−centre cohort study in two liver transplant centres (LTCs) and eight non-transplant centres (NTCs) across Australia to assess for variation in patterns of care and key survival outcomes.

 

Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC, first diagnosed between 01/01/2016 and 31/12/2020 who were managed at a participating site were included in the study. Patients were excluded if they had a history of prior HCC or if they received upfront liver transplantation.

 

A total of 887 patients were included in the study, with 433 patients managed at LTC and 454 patients managed at NTC. Management at a LTC did not significantly predict allocation to resection using multivariable binary logistic regression adjusting for tumour burden as well as age, gender, liver disease aetiology, liver disease severity and medical comorbidities (adjusted OR 0.75 95%CI 0.50 to 1.11, p=0.148). However, in those not receiving resection, LTC and NTC patients were systematically managed differently, with LTC patients five times less likely to receive upfront ablation than NTC patients (adjusted OR 0.19, 95%CI 0.13 to 0.28, p<0.001). LTC patients had significantly higher proportions of patients undergoing TACE for every tumour burden category, including those with single tumour 2cm or less (p<0.001). 42 of 887 patients (4.7%) underwent transplantation during follow-up, with higher Charlson Comorbidity Index (CCI) in LTC patients who received liver transplant compared to NTC patients (median 5 vs 3, p=0.028). Using multivariable Cox−proportional hazards analysis, management at a transplant centre was associated with reduced all−cause mortality (adjusted HR 0.71, 95%CI 0.51 to 0.98, p=0.036) and competing−risk regression analysis considering liver transplant as a competing event demonstrated a similar reduction in risk (adjusted HR 0.70., 95% CI 0.50 to 0.99, p=0.041).