Stage-specific comparative effectiveness of locoregional therapies in early-stage hepatocellular carcinoma: A global real-world analysis.

Abstract

e16277 Background: Locoregional therapies are central to the management of early-stage hepatocellular carcinoma (HCC) in patients who are not candidates for surgical resection. Transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and thermal ablation (radiofrequency or microwave ablation; RFA/MWA) are widely used, yet comparative, stage-specific real-world effectiveness data remain limited. Methods: We conducted a retrospective comparative effectiveness analysis using the TriNetX global research network. Adults with early-stage HCC treated with TACE, TARE, or ablation as first locoregional therapy were stratified by tumor stage (T1 vs T2). Propensity score matching was performed within each head-to-head comparison to balance demographics, liver disease severity, comorbidities, and baseline characteristics. Overall survival (OS) was the primary endpoint. Results: T1 tumors: After matching, 224 patients per group were included for TACE versus TARE. Three-year OS was significantly lower with TACE compared with TARE (62% vs 75%, p = 0.0076). Ablation versus TACE included 236 patients per group, with 1-year OS of 89% versus 83% ( p = 0.0595) and 3-year OS of 69% versus 63% ( p = 0.1063). Ablation versus TARE included 233 patients per group, with 1-year OS of 90% versus 89% ( p = 0.7288) and 3-year OS of 69% versus 71% ( p = 0.7925). T2 tumors: After matching, 157 patients per group were analyzed for TACE versus TARE, with 3-year OS of 59% versus 66% ( p = 0.0579). Ablation versus TACE included 108 patients per group (1-year OS 86% vs 89%; p = 0.6608; 3-year OS 57% vs 58%; p = 0.7989). Ablation versus TARE included 114 patients per group (1-year OS 85% vs 80%; p = 0.3342; 3-year OS 59% vs 58%; p = 0.2089). Conclusions: In T1 HCC, stage-specific survival differences were observed, with TARE and ablation demonstrating superior survival compared with TACE and no significant difference between TARE and ablation. No survival differences were identified among T2 patients, likely reflecting limited statistical power due to smaller sample sizes. Larger prospective studies are needed to more definitively compare survival outcomes of locoregional therapies across disease stages.