Treatment modalities and survival outcomes in patients with hepatocellular carcinoma with brain metastases (HCC-BM): A large national study.

e14007 Background: Hepatocellular carcinoma (HCC) with brain metastases (BM) is a rare and aggressive condition with poor survival outcomes and only a few case series and reports documented. This study retrospectively evaluated treatment modalities and prognostic factors for HCC patients with BM using data from the National Cancer Database (NCDB) between 2010 and 2022. Methods: Treatment modalities included systemic therapy (ST), whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), ST combined with WBRT, and ST combined with SRS. Kaplan-Meier analysis estimated median overall survival (OS). Cox proportional hazard models were employed to adjust for demographic and clinical variables, including age, race, Charlson-Deyo comorbidity score, and insurance status, with hazard ratios (HR) reported for mortality. Results: Of 37,997 patients with stage-IV HCC, 721 (1.9%) were diagnosed with BM. Most HCC-BM patients were < 65 years-old (54.6%), White (77.6%), and Medicaid/Medicare insured (61.98%). The OS was 3.84 months (95% CI: 3.45–4.57). Charlson-Deyo score was 0 in 53.6%. Treatment was mostly ST (42.5%), followed by WBRT (19.5%), SRS (9.9%), ST+WBRT (14.1%), and SRS+ST (14.1%). Patients treated with SRS+ST had the longest OS (7.43 months; 95% CI:6.05–9.95) followed by ST (5.26 months; 95% CI: 4.04–6.44). SRS alone was associated with an OS of 2 months (95% CI:1.41–3.45), while WBRT with the shortest OS (1.51 months; 95% CI:1.12–2.23, P < 0.001). Patients treated with SRS+ST showed the best survival outcomes, with a 6-month OS rate of 68.3% (95% CI: 51.74–80.19%) and a 24-month OS rate of 22.0% (95% CI: 10.9–35.5%) but may denote selection bias for patients with improved prognosis and/or functional status. Older age (≥65 years; HR: 1.45, P = 0.014) and comorbidity index ≥1 (HR: 1.35, P = 0.024) were associated with poor OS. Conclusions: This study provides the first large-scale analysis of HCC patients with BM. SRS+ST was associated with improved OS. Further studies are needed to prospectively explore the efficacy of SRS+ST in this rare population. Survival rates by treatment modality, % (95% CI). Treatment 6-Months 1-Year 2-Years ST 45.15% (36.01–53.84%) 24.86% (17.40–33.03%) 11.37% (6.34–18.01%) WBRT 13.23% (5.58–24.24%) - - SRS 12.50% (3.14–28.65%) 4.17% (0.30–17.59%) 4.17% (0.30–17.59%) WBRT+ST 33.33% (19.76–47.50%) 19.05% (8.94–32.03%) 7.14% (1.85–17.45%) SRS+ST 68.29% (51.74–80.19%) 24.39% (12.65–38.17%) 21.95% (10.87–35.48%)