Abstract
BACKGROUND: Treatment algorithms for hepatocellular carcinoma (HCC) account for tumor burden/stage and severity of liver disease. There are conflicting data on the differential benefit of curative versus non-curative treatments based on BCLC stage. Therefore, we sought to leverage a nationally representative sample of patients in the Veterans Health Administration (VHA) to address this question. METHODS: We performed a retrospective cohort study of patients with cirrhosis and HCC in the VHA. We conducted a landmark analysis and fit survival models, censored at 3 years, to evaluate the association of treatment type based on the highest level (non-curative vs. curative vs. combination), stratified by BCLC stage, for patients with early-stage to intermediate-stage HCC. RESULTS: We evaluated 1191 patients with confirmed HCC (535 received only non-curative treatment, 227 only curative, and 429 received a combination of curative and non-curative). Among BCLC-0 patients, patients who received curative-intent therapy had significantly better survival at all time points compared with patients receiving non-curative treatment only (HR ranging from 0.53 at 6 months to 0.77 at 3 years). In contrast, for patients with BCLC-A stage disease, receiving either curative treatment alone or combination therapy was associated with significantly better survival compared with non-curative treatment (HR ranged from 0.41 to 0.76 over the study period). However, for BCLC-B stage disease, only combination therapy had significantly better survival (HR 0.44 at 6 months to 0.65 at 3 years). CONCLUSIONS: Our real-world data demonstrate that among patients with early-stage to intermediate-stage HCC, curative-intent treatment is associated with the best survival for patients with BCLC-0 and BCLC-A stage disease, while combination therapy yields the best outcomes in patients with BCLC-B stage disease.