03:36 PM Abstract No. 232 Evaluation of a new prognostic scoring system for hepatocellular carcinoma patients and portal vein invasion treated with radioembolization in a 152-patient cohort

Abstract

To evaluate a new prognostic scoring system to delineate survival benefit for patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) undergoing ytrrium-90 radioembolization (Y90). With IRB approval, a retrospective chart review (2004-2017) of HCC patients (Child-Pugh A-B7) with PVTT and no extra-hepatic metastases at time of Y90 was performed. We employed a recently published prognostic system (Spreafico et al., Journal of Hepatology, 2018) to stratify outcomes with 3 variables: Baseline tumor burden (visual estimation): < 50% tumor burden =0 and >50% tumor burden =3; Serum bilirubin: ≤ 1.2 mg/dl =0 and >1.2 mg/dl =2; Portal vein involvement: segmental PVTT =0, lobar PVTT =2, and main portal or superior mesenteric vein tumor thrombosis =3. Three prognostic subgroups were created from total score: favorable (0-1 points), intermediate (2-3 points), and poor (> 3 points) prognosis. The hazard ratio (HR) comparing each subgroup was calculated. Overall survival (OS) was evaluated with Kaplan-Meier analysis. 152 patients met inclusion criteria; 16% were alive at date of data extraction. Median OS of cohort was 8.7 (95% CI, 7.7-11.4). Median OS for prognostic subgroups were: favorable (n=35, 23%) 13.3 (95% CI, 8.0-15.6), intermediate (n=82, 54%) 9.1 (95% CI, 7.7-14.2), and poor (n=35, 23%) 5.3 (95% CI, 4.1-8.4) months, respectively. These numbers are lower than Spreafico et al: Median OS in 3 categories was 32.2, 14.9 and 7.8 months, respectively. The HR of the favorable subgroup was 1.1 and 1.9 compared to intermediate and poor subgroups, respectively (p<0.05). The HR of the intermediate subgroup was 0.95 and 1.8 compared to favorable and poor subgroups, respectively (p<0.05). The poor subgroup HR was 0.53 and 0.56 compared to favorable and intermediate subgroups, respectively (p<0.05). A prognostic scoring system for patients with HCC and PVTT including serum bilirubin, tumor burden, and level of PVT can delineate survival benefit from Y90. However, we are unable to replicate outcomes by the Spreafico group. Further patient stratification might be required to validate this novel system. be required to validate this novel system.