Interventional Radiology as the Most Utilized Treatment Specialty for Hepatocellular Carcinoma: A 25-Year
Arsalan Nadeem1, Laura M Kulik2, Aparna Kalyan3
1Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Purpose:
To characterize the longitudinal role of interventional radiology (IR) in multidisciplinary hepatocellular carcinoma (HCC) care over 25 years at a high-volume liver transplant center, and to evaluate changes in IR utilization and procedural composition following FDA approval of atezolizumab plus bevacizumab (Atezo/Bev) as first-line systemic therapy.
Materials And Methods:
This retrospective single-center cohort included patients 3,473 patients with HCC (ICD-9: 155.0; ICD-10: C22.0) treated between 2000 and 2025. The cohort was 71.7% male, with a median age of 64 years. Data were obtained from institutional procedure records and CPT codes. Outcomes included patients and procedures by specialty, IR procedural mix by era, treatment sequencing, and peri-transplant patterns. Analyses included descriptive statistics and chi-square tests.
Results:
IR treated 2,520 (72.6%) and performed 4,313 procedures, including TARE (72.6%), TACE (18.7%), and ablation (7.9%). Surgery treated 1,350 (38.9%), medical oncology 746 (21.5%), and radiation oncology 96 (2.8%). Of 939 liver transplant patients, 510 (54.3%) received IR pre-transplant at a median of 201 days, primarily TARE (67.0%). After Atezo/Bev approval, IR patient proportion declined from 75.7% to 64.6% (p<0.001), while annual procedural volume remained stable (151 vs 192, p=0.366). TARE increased from 67.4% to 86.8% of procedures, while TACE decreased from 24.7% to 2.3%.
Conclusion:
Over 25 years, IR was the most utilized specialty in HCC care. TARE became the dominant locoregional and bridging therapy. After Atezo/Bev approval, IR utilization proportion declined, but procedural volume remained stable with a marked shift toward TARE and away from TACE.
