Socioeconomic and demographic predictors of transarterial chemoembolization outcomes for hepatic malignancies.

Abstract

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.