Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Initial trans-arterial chemo-embolisation (TACE) is associated with similar survival outcomes as compared to upfront percutaneous ablation in those with single hepatocellular carcinoma (HCC) ≤ 3cm: results of a real-world propensity-matched multi-centre Australian cohort study (#429)

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 , Jactina 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 2 , Stephen Riordan 12 , Nicholas Hannah 13 , James Haridy 13 , Siddharth Sood 13 , Eileen Lam 1 , Elysia Greenhill 1 , Liane Ioannou 1 , John Lubel 1 2 , William Kemp 1 2 , Ammar Majeed 1 2 , John Zalcberg 1 2 , Stuart Roberts 1 2
  1. Monash University, Melbourne, VIC, Australia
  2. Alfred Health, 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

Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤3cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation.

 

Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study.

 

A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank test p=0.652) or liver-related survival (log-rank test p=0.495) over a median follow up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs 56%, p<0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs 80% p=0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival was similar (log rank test p=0.355 and p=0.390 respectively).

 

Our study provides valuable real-world evidence that TACE when offered with appropriate follow up treatment is a reasonable initial management strategy in very-early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed in this area.