Abstract
To identify key clinical and imaging predictors of survival in patients undergoing Yttrium-90 radioembolization (Y90-RE) for advanced, Barcelona Clinic Liver Cancer (BCLC) C, hepatocellular carcinoma (HCC). In an IRB-approved study, patients with BCLC C HCC who underwent Y90-RE were retrospectively identified. Reason for BCLC C Status (i.e., Eastern Cooperative Oncology Group performance status (ECOG-PS), macrovascular invasion, and/or extrahepatic metastasis) and additional pre and post Y90-RE prognostic factors were recorded and analyzed. Median overall survival (OS) from first Y90-RE was calculated using Kaplan-Meier estimation and potential prognostic factors were tested for significance (p ≤0.05) using log-rank analysis. Between 2013 and 2018, 97 BCLC C HCC patients (79% male; 65 years mean age) underwent Y90-RE with a median OS (95% CI) of 13.7 months (10.8-16.9). Median OS for the 40 (41%) ECOG-PS driven BCLC C patients versus the 57 (59%) macrovascular invasion and/or extrahepatic metastasis driven BCLC C patients was 14.5 (10.8-20.5) versus 13.2 (6.9-16.9) months, respectively (p = 0.9). Prognostic factors associated with a prolonged median OS were absence of hepatic vein invasion (14.9 vs. 5.3; p = 0.0002), single hepatic lobe burden (15.4 vs. 7.2; p = 0.04), absence of anorexia (14.6 vs. 6.1; p = 0.004), normal baseline alkaline phosphatase (19.1 vs. 9.0; P <0.0001), normal baseline serum sodium (14.9 vs. 5.2; p = 0.01), greater post Y90-RS tumor shrinkage (14.9 vs. 5.2; p = 0.01), attainment of Milan eligibility status (20.8 vs. 9.6; p = 0.001), and complete/partial tumor response per mRECIST (17.5 vs. 7.3; p = 0.01). Y90-RE is an effective therapy for the treatment of BCLC C hepatocellular carcinoma patients, resulting in an overall survival that is equivalent, if not favorable, to currently allocated therapies per BCLC guidelines. Certain pre Y90-RE clinical and imaging characteristics are associated with an improved overall survival.Tabled 1Prognostic Factors, in median OS (95% CI) monthsPresentAbsentPHepatic vein invasion5.314.90.0002Single hepatic lobe burden15.47.20.04Anorexia6.114.60.004Normal baseline alkaline phosphatase19.19.00.0001Normal baseline sodium blood levels18.07.10.014Greater tumor shrinkage14.95.20.01Attained Milan eligibility status20.89.60.001Attained complete or partial tumor response, per mRECIST17.57.30.01 Open table in a new tab
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