Effectiveness of initial transarterial chemoembolization for hepatocellular carcinoma among Medicare beneficiaries

Hanna K. Sanoff, Yunkyung Chang, Joseph Stavas, Til Stürmer, Jennifer Lund

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Optimal administration of transarterial chemoembolization (TACE), the standard approach for intermediate-stage hepatocellular carcinoma (HCC), requires clinical and technical expertise. We sought to evaluate whether TACE retains its effectiveness when administered across a broad range of health care settings. Furthermore, as the use of yttrium90 (Y90) radioembolization has been increasing, we explored the comparative effectiveness of Y90 as an alternative to TACE. Methods: Patients with HCC diagnosed from 2004 through 2009 treated initially with TACE or Y90 were identified from the SEER-Medicare linkage. Key covariates included prediagnosis α-fetoprotein (AFP) screening, complications of cirrhosis, and tumor extent. Effect of treatment, patient, and health care system factors on overall survival (OS) was evaluated using multivariable Cox proportional hazards. Stratified OS estimates are provided. Propensity score (PS) weighting was used to compare effectiveness of Y90 with TACE. Results: Of 1528 patients who underwent intra-arterial embolization, 577 received concurrent chemotherapy (eg, TACE). Median OS was 21 months (95% CI, 18-23) following TACE and 9 months (95% CI, 1-41) following Y90. Refined survival estimates stratified by stage, AFP screening, and liver comorbidity are presented. The 90-day mortality rate after TACE was 21% to 25% in patients with extrahepatic spread or vascular invasion. In the PS-weighted analysis, Y90 was associated with inferior survival, with an adjusted hazard ratio of 1.39 (95% CI, 1.02-1.90). Conclusions: The effectiveness of TACE is generalizable to Medicare patients receiving care in a variety of treatment settings. However, early posttreatment mortality is high in patients with advanced disease. We found no evidence of improved outcomes with Y90 compared with TACE. Survival estimates from this large cohort can be used to provide prognostic information to patients considering palliative TACE.

Original languageEnglish
Pages (from-to)1102-1110
Number of pages9
JournalJournal of the National Comprehensive Cancer Network : JNCCN
Volume13
Issue number9
StatePublished - Sep 1 2015
Externally publishedYes

Fingerprint

Medicare
Hepatocellular Carcinoma
Survival
Propensity Score
Patient Care
Fetal Proteins
Professional Competence
Delivery of Health Care
Mortality
Blood Vessels
Comorbidity
Fibrosis
Drug Therapy
Liver
Therapeutics
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Effectiveness of initial transarterial chemoembolization for hepatocellular carcinoma among Medicare beneficiaries. / Sanoff, Hanna K.; Chang, Yunkyung; Stavas, Joseph; Stürmer, Til; Lund, Jennifer.

In: Journal of the National Comprehensive Cancer Network : JNCCN, Vol. 13, No. 9, 01.09.2015, p. 1102-1110.

Research output: Contribution to journalArticle

@article{614ce45503e3449bb147fcb15a0b1f58,
title = "Effectiveness of initial transarterial chemoembolization for hepatocellular carcinoma among Medicare beneficiaries",
abstract = "Background: Optimal administration of transarterial chemoembolization (TACE), the standard approach for intermediate-stage hepatocellular carcinoma (HCC), requires clinical and technical expertise. We sought to evaluate whether TACE retains its effectiveness when administered across a broad range of health care settings. Furthermore, as the use of yttrium90 (Y90) radioembolization has been increasing, we explored the comparative effectiveness of Y90 as an alternative to TACE. Methods: Patients with HCC diagnosed from 2004 through 2009 treated initially with TACE or Y90 were identified from the SEER-Medicare linkage. Key covariates included prediagnosis α-fetoprotein (AFP) screening, complications of cirrhosis, and tumor extent. Effect of treatment, patient, and health care system factors on overall survival (OS) was evaluated using multivariable Cox proportional hazards. Stratified OS estimates are provided. Propensity score (PS) weighting was used to compare effectiveness of Y90 with TACE. Results: Of 1528 patients who underwent intra-arterial embolization, 577 received concurrent chemotherapy (eg, TACE). Median OS was 21 months (95{\%} CI, 18-23) following TACE and 9 months (95{\%} CI, 1-41) following Y90. Refined survival estimates stratified by stage, AFP screening, and liver comorbidity are presented. The 90-day mortality rate after TACE was 21{\%} to 25{\%} in patients with extrahepatic spread or vascular invasion. In the PS-weighted analysis, Y90 was associated with inferior survival, with an adjusted hazard ratio of 1.39 (95{\%} CI, 1.02-1.90). Conclusions: The effectiveness of TACE is generalizable to Medicare patients receiving care in a variety of treatment settings. However, early posttreatment mortality is high in patients with advanced disease. We found no evidence of improved outcomes with Y90 compared with TACE. Survival estimates from this large cohort can be used to provide prognostic information to patients considering palliative TACE.",
author = "Sanoff, {Hanna K.} and Yunkyung Chang and Joseph Stavas and Til St{\"u}rmer and Jennifer Lund",
year = "2015",
month = "9",
day = "1",
language = "English",
volume = "13",
pages = "1102--1110",
journal = "Journal of the National Comprehensive Cancer Network : JNCCN",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "9",

}

TY - JOUR

T1 - Effectiveness of initial transarterial chemoembolization for hepatocellular carcinoma among Medicare beneficiaries

AU - Sanoff, Hanna K.

AU - Chang, Yunkyung

AU - Stavas, Joseph

AU - Stürmer, Til

AU - Lund, Jennifer

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background: Optimal administration of transarterial chemoembolization (TACE), the standard approach for intermediate-stage hepatocellular carcinoma (HCC), requires clinical and technical expertise. We sought to evaluate whether TACE retains its effectiveness when administered across a broad range of health care settings. Furthermore, as the use of yttrium90 (Y90) radioembolization has been increasing, we explored the comparative effectiveness of Y90 as an alternative to TACE. Methods: Patients with HCC diagnosed from 2004 through 2009 treated initially with TACE or Y90 were identified from the SEER-Medicare linkage. Key covariates included prediagnosis α-fetoprotein (AFP) screening, complications of cirrhosis, and tumor extent. Effect of treatment, patient, and health care system factors on overall survival (OS) was evaluated using multivariable Cox proportional hazards. Stratified OS estimates are provided. Propensity score (PS) weighting was used to compare effectiveness of Y90 with TACE. Results: Of 1528 patients who underwent intra-arterial embolization, 577 received concurrent chemotherapy (eg, TACE). Median OS was 21 months (95% CI, 18-23) following TACE and 9 months (95% CI, 1-41) following Y90. Refined survival estimates stratified by stage, AFP screening, and liver comorbidity are presented. The 90-day mortality rate after TACE was 21% to 25% in patients with extrahepatic spread or vascular invasion. In the PS-weighted analysis, Y90 was associated with inferior survival, with an adjusted hazard ratio of 1.39 (95% CI, 1.02-1.90). Conclusions: The effectiveness of TACE is generalizable to Medicare patients receiving care in a variety of treatment settings. However, early posttreatment mortality is high in patients with advanced disease. We found no evidence of improved outcomes with Y90 compared with TACE. Survival estimates from this large cohort can be used to provide prognostic information to patients considering palliative TACE.

AB - Background: Optimal administration of transarterial chemoembolization (TACE), the standard approach for intermediate-stage hepatocellular carcinoma (HCC), requires clinical and technical expertise. We sought to evaluate whether TACE retains its effectiveness when administered across a broad range of health care settings. Furthermore, as the use of yttrium90 (Y90) radioembolization has been increasing, we explored the comparative effectiveness of Y90 as an alternative to TACE. Methods: Patients with HCC diagnosed from 2004 through 2009 treated initially with TACE or Y90 were identified from the SEER-Medicare linkage. Key covariates included prediagnosis α-fetoprotein (AFP) screening, complications of cirrhosis, and tumor extent. Effect of treatment, patient, and health care system factors on overall survival (OS) was evaluated using multivariable Cox proportional hazards. Stratified OS estimates are provided. Propensity score (PS) weighting was used to compare effectiveness of Y90 with TACE. Results: Of 1528 patients who underwent intra-arterial embolization, 577 received concurrent chemotherapy (eg, TACE). Median OS was 21 months (95% CI, 18-23) following TACE and 9 months (95% CI, 1-41) following Y90. Refined survival estimates stratified by stage, AFP screening, and liver comorbidity are presented. The 90-day mortality rate after TACE was 21% to 25% in patients with extrahepatic spread or vascular invasion. In the PS-weighted analysis, Y90 was associated with inferior survival, with an adjusted hazard ratio of 1.39 (95% CI, 1.02-1.90). Conclusions: The effectiveness of TACE is generalizable to Medicare patients receiving care in a variety of treatment settings. However, early posttreatment mortality is high in patients with advanced disease. We found no evidence of improved outcomes with Y90 compared with TACE. Survival estimates from this large cohort can be used to provide prognostic information to patients considering palliative TACE.

UR - http://www.scopus.com/inward/record.url?scp=84941780606&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941780606&partnerID=8YFLogxK

M3 - Article

C2 - 26358794

AN - SCOPUS:84941780606

VL - 13

SP - 1102

EP - 1110

JO - Journal of the National Comprehensive Cancer Network : JNCCN

JF - Journal of the National Comprehensive Cancer Network : JNCCN

SN - 1540-1405

IS - 9

ER -