Cancers (May 2024)

Different Patterns of Care and Survival Outcomes in Transplant-Centre Managed Patients with Early-Stage HCC: Real-World Data from an Australian Multi-Centre Cohort Study

  • Jonathan Abdelmalak,
  • Simone I. Strasser,
  • Natalie L. Ngu,
  • Claude Dennis,
  • Marie Sinclair,
  • Avik Majumdar,
  • Kate Collins,
  • Katherine Bateman,
  • Anouk Dev,
  • Joshua H. Abasszade,
  • Zina Valaydon,
  • Daniel Saitta,
  • Kathryn Gazelakis,
  • Susan Byers,
  • Jacinta Holmes,
  • Alexander J. Thompson,
  • Dhivya Pandiaraja,
  • Steven Bollipo,
  • Suresh Sharma,
  • Merlyn Joseph,
  • Rohit Sawhney,
  • Amanda Nicoll,
  • Nicholas Batt,
  • Myo J. Tang,
  • Stephen Riordan,
  • Nicholas Hannah,
  • James Haridy,
  • Siddharth Sood,
  • Eileen Lam,
  • Elysia Greenhill,
  • John Lubel,
  • William Kemp,
  • Ammar Majeed,
  • John Zalcberg,
  • Stuart K. Roberts

DOI
https://doi.org/10.3390/cancers16111966
Journal volume & issue
Vol. 16, no. 11
p. 1966

Abstract

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The management of early-stage hepatocellular carcinoma (HCC) is complex, with multiple treatment strategies available. There is a paucity of literature regarding variations in the patterns of care and outcomes between transplant and non-transplant centres. We conducted this real-world multi-centre cohort study in two liver cancer referral centres with an integrated liver transplant program and an additional eight non-transplant HCC referral centres across Australia to identify variation in patterns of care and key survival outcomes. Patients with stage Barcelona Clinic Liver Cancer (BCLC) 0/A HCC, first diagnosed between 1 January 2016 and 31 December 2020, who were managed at a participating site, were included in the study. Patients were excluded if they had a history of prior HCC or if they received upfront liver transplantation. A total of 887 patients were included in the study, with 433 patients managed at a liver cancer centre with a transplant program (LTC) and 454 patients managed at a non-transplant centre (NTC). Management at an LTC did not significantly predict allocation to resection (adjusted OR 0.75, 95% CI 0.50 to 1.11, p = 0.148). However, in those not receiving resection, LTC and NTC patients were systematically managed differently, with LTC patients five times less likely to receive upfront ablation than NTC patients (adjusted OR 0.19, 95% CI 0.13 to 0.28, p p p = 0.036), and competing-risk regression analysis, considering liver transplant as a competing event, demonstrated a similar reduction in risk (adjusted HR 0.70, 95% CI 0.50 to 0.99, p = 0.041), suggesting that the reduced risk of death is not fully explained by higher rates of transplantation. Our study highlights systematic differences in HCC care between large volume liver transplant centres and other sites, which has not previously been well-described. Further work is needed to better define the reasons for differences in treatment allocation and to aim to minimise unwarranted treatment variation to maximise patient outcomes across Australia.

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