Efficacy of local therapy in Chinese patients with BCLC stage C hepatocellular carcinoma (HCC): A retrospective cohort study of 370 patients over six years.

Abstract

e16228 Background: Even though systemic therapy has been recommended as the standard of care for advanced HCC at Barcelona Clinic Liver Cancer (BCLC) stage C, the prognosis of these patients remains poor. Combination with local therapy shows potential for improved clinical benefits in consideration of their synergistic effect. Recently, several studies have reported the preliminary efficacy and safety of these combined regimens. However, the long-term outcomes are still ambiguous. This study aims to clarify the prognostic value of local therapy in the real world for advanced HCC. Methods: This cohort study retrospectively analyzed the clinical data of 370 BCLC stage C HCC patients in the First Hospital of Shanxi Medical University from May 2013 to August 2023. Depending on whether they received local therapy (transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, local ablation, seed implantation) based on systemic therapy, patients were divided into two cohorts. The primary endpoint was the overall survival (OS). Multivariate Cox regression model and overlap-weighted propensity score matching (PSM) were implemented in this study. Results: Of all the participants (N = 370), 78.65% were male, mean (SD) age 61.5 (11.1), 57.57% Child-Pugh A, 42.43% Child-Pugh B. Median survival time of the non-local therapy group (N = 98) was 7 months while the local therapy group (N = 272) was 15 months. Multivariable Cox regression analysisshowed that age ≥ 65 (HR = 1.63, 95% CI 1.28-2.08, p < 0.001), lymph node metastasis (HR = 1.67, 95% CI 1.28-2.17, p < 0.001), ascites (HR = 1.35, 95% CI 1.01-1.81, p = 0.042), tumor diameter ≥ 5 cm (HR = 1.54, 95% CI 1.18-2.00, p < 0.001), α-fetoprotein level (AFP) ≥ 550 ng/mL (HR = 1.31, 95% CI 1.02-1.68, p = 0.032), and systemic immune-inflammation index (SII) ≥ 500 (HR = 1.58, 95% CI 1.08-2.31, p = 0.019) were associated with a higher risk of all-cause mortality. Furthermore, local therapy as a protective factor reduced the risk of death (HR = 0.64, 95% CI 0.50-0.84, p = 0.001). Overlap-weighted PSM dataset (66 pairs) analysis also confirmed the value of local therapy (HR = 0.62, 95% CI 0.48-0.81, p < 0.001). In addition, through long-term follow-up, we found that the OS rates of 1, 2, 3, 4, and 5 years in the local therapy group were better than those in the non-local therapy group, as shown in Table 1. Conclusions: This study demonstrates that local therapy significantly improves survival outcomes for Chinese advanced HCC patients, underscoring its crucial role in therapeutic strategies. 5-year survival rates of all patients. Years Non-Local therapy Local therapy Survival Rate (%) 95% CI (%) Survival Rate (%) 95% CI (%) 1 28.57 20.02-37.69 59.91 53.83-65.46 2 15.13 8.85-24.18 32.69 27.16-38.33 3 5.4 2.02-11.26 21.29 16.37-26.60 4 5.4 2.02-11.26 14.07 9.71-19.22 5 3.6 0.89-9.62 11.71 7.56-16.85