Socioeconomic and demographic predictors of transarterial chemoembolization outcomes for hepatic malignancies
Aaron Chafitz1, Rohan Makhiani2, Erin Niederkohr2
1Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue Columbus, OH 43210, USA.
Rationale And Objectives:
This study aimed to evaluate the socioeconomic and demographic factors that predict overall survival (OS) and progression-free survival (PFS) of patients undergoing transarterial chemoembolization (TACE) for primary and metastatic hepatic disease.
Materials And Methods:
Retrospective review from 2016 to 2022 identified 322 patients with hepatocellular carcinoma (HCC) (n = 234) and metastatic liver lesions (n = 98), treated with TACE. Patients were stratified by demographic factors, including mean income, insurance status, race, and social vulnerability index (SVI), a Center for Disease control (CDC) composite measure from geographic census data. Primary outcomes measures included OS and PFS. Correlation, multivariate regression, and Kaplan Meier analyses were performed.
Results:
Of the studied population, 67 % were male, 85 % were White, and 62 % had Medicare coverage, with a mean age of 64 years. Mean OS was 25.6 months, and PFS was 19.9 months. The liver-specific disease progression rate and overall mortality rate were 71.7 % and 56.9 %, respectively. Lower SVI group, indicating less social vulnerability, was positively correlated with OS (p = 0.033), and a similar trend was observed for PFS (p = 0.0676) in the overall population. Co-variate analysis demonstrated statistically significant relationship between SVI and OS (HR=3.880, p = 0.01), controlling for underlying disease (HCC vs. metastatic disease) and baseline health characteristics.
Conclusions:
Findings highlight underexplored relationships between social factors and treatment outcomes, revealing SVI as a predictive factor of OS following TACE. Further work is warranted to better understand disparities associated with procedural interventions to target mitigation strategies.
