P4575 - Mortality of Locoregional Therapy Outcomes for Hepatocellular Cancer Patients With Advanced HCC Stage Based on Performance Status

Arjun Juneja, BS¹, Merete Lund, MD², Yue Jiang, PhD³, Chidi Iloabachie, BS⁴, Sydney Power, MD², Gabe Lupu, MD², Joyce Badal, MD¹, David Seligson, MS⁵, Hanna Sanoff, MD², David Mauro, MD², David Gerber, MD⁶, Ted Yanagihara, MD², Alfred S. Barritt, MD, MSCR⁷, Andrew Moon, MD, MPH^2
1University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ²University of North Carolina, Chapel Hill, NC; ³Duke University, Chapel Hill, NC; ⁴University of North Carolina at Chapel Hill School of Medicine, Carrboro, NC; ⁵Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC; ⁶University of Cincinnati, Chapel Hill, NC; ⁷UNC, Chapel Hill, NC

Introduction: The Barcelona Clinic Liver Cancer (BCLC) staging is a widely accepted algorithm for patients with Hepatocellular Cancer (HCC) that includes tumor size, quantity and extrahepatic spread, performance status (PS), and liver function. BCLC staging has been extensively validated as a predictor of prognosis. However, there is concern about inconsistent understanding and variability in assessing PS. PS-0 is categorized as normal, baseline activity while PS-1 is fully ambulatory with some symptoms. Specifically, those with a PS >1 are upgraded to BCLC-C stage. This study seeks to examine prognosis of patients who qualify as BCLC-C based on PS, as assessed by clinicians as a single tertiary cancer center.

Methods: We conducted a retrospective analysis of patients with HCC who received locoregional therapy (thermal ablation, transarterial chemo- or radioembolization, external beam radiation therapy) at a tertiary cancer center between 2014 and 2021. Patients were followed until death, liver transplant or censoring. For patients with multiple treatments, we used only information from their initial treatment. We utilized multivariable Cox models to examine relationship between PS and death, adjusting for age, Charlson Comorbidity Index, treatment type, liver disease etiology, and TNM tumor stage.

Results: There were 211 patients in our cohort, 137 of performance status 0 with BCLC A or B staging, and 74 BCLC-C based on performance status 1-2. Patients with BCLC C stage based on ECOG PS 1-2 were much less likely to receive ablation compared to patients with BCLC A or B staging. There was a statistically significant association between survival and PS status (log-rank test p = 0.001), with patients classified as PS 1 and 2 having lower estimated survival probability compared to patients with PS 0 (Figure 1). After adjustment for covariates, there were statistically significant differences in survival in PS 0 vs. 2 (aHR 2.73, 95% CI 1.27 – 5.89) but no statistically significant difference for PS 0 vs. 1 (aHR 1.13; 95% CI: 0.66 – 1.95).

Discussion: Our results demonstrate that for patients with the same tumor burden, PS 2 is associated with higher mortality vs PS 0. This difference was not statistically significant for PS 1 vs 0 after adjusting for confounders. This suggests that there may be misunderstanding of how to apply PS 1 among clinicians leading to misclassification or that ECOG PS 0-1 should be grouped together in tumor staging systems.



Disclosures:


Arjun Juneja, BS¹, Merete Lund, MD², Yue Jiang, PhD³, Chidi Iloabachie, BS⁴, Sydney Power, MD², Gabe Lupu, MD², Joyce Badal, MD¹, David Seligson, MS⁵, Hanna Sanoff, MD², David Mauro, MD², David Gerber, MD⁶, Ted Yanagihara, MD², Alfred S. Barritt, MD, MSCR⁷, Andrew Moon, MD, MPH². P4575 - Mortality of Locoregional Therapy Outcomes for Hepatocellular Cancer Patients With Advanced HCC Stage Based on Performance Status, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.