Survival Outcomes in Hepatocellular Carcinoma Patients Undergoing TARE: A Comparative Analysis Before and After Order-Map-Treat Protocol Implementation

Background: Hepatocellular carcinoma (HCC) continues to pose a significant global health burden, especially when diagnosed at a symptomatic or advanced stage. In such cases, prompt and well-coordinated treatment plays a key role in improving patient outcomes. This study explores the effect of introducing the Order-Map-Treat (OMT) protocol, designed to streamline clinical decision-making and minimize treatment delays, on the survival of HCC patients undergoing transarterial radioembolization (TARE). Methods: This retrospective cohort included 185 HCC patients (69.2% males) of which 88 (47.6%) underwent TARE before the implementation of OMT system in 2021 (Group 1) and 97 (52.4%) afterwards (Group 2). The mean age of the entire cohort was 71±12 years. A significantly larger number of patients treated before 2021 had an ECOG score of 0 (p < 0.001). Group 1 had significantly more multifocal disease, while group 2 had more unilobar involvement. More patients with PVTT3 and PVTT4 were treated after the implementation of the OMT protocol (P=0.009). Results: The OMT protocol significantly reduced the median decision to treatment period (P-value = < 0.001) from 37 days to 15 days and mapping to TARE period from 21 days to 1 day shortening the total days needed for treatment by 32 days approximately. The median survival from TARE was 1.4 years (95% CI: 1.1 to 1.6) for the entire cohort. When stratified by treatment period, patients treated before OMT had a median survival of 1.5 years (95% CI: 1.2 to 1.9), while those treated after OMT implementation had a median survival of 1.2 years (95% CI: 0.9 to 1.6). The difference was not statistically significant (p = 0.415). Conclusion: While there were no significant survival benefits, the OMT protocol offers more efficient HCC management by minimizing delays in treatment, potentially improving patient experience and cost effectiveness.