3:00 PM Abstract No. 81 Radioembolization for hepatocellular carcinoma patients with portal vein thrombosis: a single-center 14-year experience

Abstract

To report overall survival (OS) outcomes for advanced stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with yttrium-90 radioembolization (Y90). With IRB approval we searched our prospectively acquired database for patients treated with Y90. Patients who had advanced stage HCC with tumor PVT were included. Patients who had simultaneous hepatic vein invasion and extrahepatic metastases were excluded. Clinical and laboratory data were collected at baseline and 1 month post-Y90. Toxicity was assessed using CTCAE v4.0. OS outcomes were reported and stratified by Child-Pugh (CP) and location of PVT. OS was calculated using Kaplan Meier method. Multivariate analysis was conducted using Cox-proportional hazards. A subanalysis for patients with high alpha-fetoprotein (AFP) (>100 ng/dl) was conducted. 185 patients with HCC and tumor PVT had Y90. 43(23%) patients had segmental, 65(35%) had lobar, and 77(42%) had main PVT. 74 patients (40%) were CPA, 51(28%) were CPB7 and 60(32%) were CP≥B8. New grade 3/4 toxicities were seen in 29(16%) patients for bilirubin, 23(13%) for albumin, and 5(2.6%) for alkaline phosphatase. Median OS(months) (95% CI) for CPA, CPB7, and CP≥B8 patients was 13.3(8.7-15.7), 6.9(5.3-10.1), and 3.9(2.9-5.0), respectively. For CPA patients, median OS(months) (95% CI) was 14.3(12.0-17.8) for segmental, 14.2(7.3-19.5) for lobar and 7.7(4.6-13.8) for main [P = 0.78]. For CPB7 patients, median OS (months) (95% CI) was 6.5(3.4-38) for segmental, 6.9(4.6-13.3) for lobar and 7.7(4.8-11.1) for main [P = 0.82]. For CP≥B8 patients, median OS (months) (95% CI) was 8.4(1.2-75.2) for segmental, 4.4(2.5-9.7) for lobar and 3.4(2.5-4.6) for main [P = 0.015]. Multivariate analysis showed baseline bilirubin, ascites, and AFP to be significant OS prognosticators. Out of 123 patients with high AFP, 12(10%) patients normalized their AFP levels (<13) with a median OS of 23.9 months (CI:20.1-124.1). Y90 can serve as a safe and effective treatment for advanced HCC patients with tumor PVT, particularly for those with preserved liver function. OS is affected by baseline liver function, tumor size, and AFP level. Location of PVT had a significant effect on OS in CP≥B8.