S2559 Characteristics Associated With the Undertreatment of Hepatocellular Carcinoma

Introduction: Despite advances in treatment options for hepatocellular carcinoma (HCC), there is underuse of treatment, including curative treatments. We aimed to characterize the prevalence and associated factors for treatment underuse in patients with HCC in the United States. Methods: We analyzed patients diagnosed with HCC at 4 academic hospitals between January 2010 and August 2018. We excluded patients with Barcelona Clinic Liver Cancer (BCLC) stage D beyond the Milan Criteria, as they are only eligible for best supportive care. We performed multivariable logistic regression analyses to identify factors associated with any treatment and curative treatment receipt. Results: Of 2034 patients (median age 61.5 years, 75.8% man), 1669 (82.1%) patients underwent HCC treatment and 950 (46.7%) underwent curative treatment. The most common treatments were TACE/TARE/SBRT (30.7%), ablation (20.6%), and transplantation (18.8%). 365 (17.9%) patients did not receive any treatment, including 88 (24.1%) of which were BCLC stage 0/A HCC. In multivariable analysis, any treatment was associated with age >65 (OR 0.47, 95% CI 0.33–0.68), Asian race (vs White: OR 0.57, 95% CI 0.32–0.99), lack of insurance and Medicaid (vs Medicare: OR 0.47, 95% CI 0.28–0.79 and OR 0.64, 95% CI 0.41–0.99), and Hepatology care prior to diagnosis (OR 1.64, 95% CI 1.11–2.43). Among treated patients, curative treatment was associated with Hispanic race (OR 0.73, 95% CI 0.54–0.98), Medicaid insurance (OR 0.56, 95% CI 0.37–0.84), post-SVR hepatitis C (vs viremic hepatitis C: OR 1.79, 95% CI 1.26–2.55), and primary care visit prior to diagnosis (OR 1.59, 95% CI 1.07–2.38). Of 1115 (54.8%) patients with BCLC stage 0/A HCC, 1027 (92.1%) received any treatment and 732 (65.7%) received curative treatment. HCC treatment was associated with Asian and Black race (OR 0.28, 95% CI 0.12–0.69 and OR 0.36, 95% CI 0.19–0.71), lack of insurance and Medicaid insurance (OR 0.32, 95% CI 0.13–0.76 and OR 0.43, 95% CI 0.20–0.94, respectively), and Hepatology care prior to diagnosis (OR 1.99, 95% CI 1.02–3.90). Among treated patients, curative treatment was associated with post-SVR hepatitis C (OR 1.98, 95% CI 1.27–3.09). Conclusion: Nearly 1 in 5 patients with HCC fail to undergo treatment, including underuse of curative treatments in those with early-stage HCC. These data underscore the need for interventions to increase guideline-concordant HCC treatment and promote equity in HCC management.