Abstract
AimsThe current prognostic model to estimate the survival in hepatocellular carcinoma (HCC) patients treated with transarterial hepatic selective internal radiotherapy (SIRT) is not fully characterized. The aim of this study was to establish a new scoring model including assessment of both tumor responses and therapy-induced systemic changes in HCC patients to predict survival at an early time point post-SIRT.Methods and materialsBetween 2008 and 2012, 149 HCC patients treated with SIRT were included into this study. CT images and biomarkers in blood tested at one month post-SIRT were analyzed and correlated with clinical outcome. Tumor responses were assessed by RECIST 1.1, mRECIST, and Choi criteria. Kaplan-Meier methods were used to estimate survival curves. Cox regression was used in uni- and multivariable survival analyses and in the establishment of a prognostic model.ResultsA multivariate proportional hazards model was created based on the tumor response, the number of tumor nodules, the score of the model for end stage liver disease (MELD), and the serum C-reactive protein levels which were independent predictors of survival in HCC patients at one month post-SIRT. This prognostic model accurately differentiated the outcome of patients with different risk scores in this cohort (P<0.001). The model also had the ability to assign a predicted survival probability for individual patients.ConclusionsA new model to predict survival of HCC patients mainly based on tumor responses and therapy-induced systemic changes provides reliable prognosis and accurately discriminates the survival at an early time point after SIRT in these patients.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide with increasing incidence especially in the western world [1,2]
A multivariate proportional hazards model was created based on the tumor response, the number of tumor nodules, the score of the model for end stage liver disease (MELD), and the serum C-reactive protein levels which were independent predictors of survival in HCC patients at one month post-Selective internal radioembolization (SIRT)
A new model to predict survival of HCC patients mainly based on tumor responses and therapy-induced systemic changes provides reliable prognosis and accurately discriminates the survival at an early time point after SIRT in these patients
Summary
Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide with increasing incidence especially in the western world [1,2]. For patients who are not eligible for curative treatments with mainly intrahepatic disease, local-ablative therapies play an important role in reducing tumor burden, providing palliation of symptoms, and increasing survival [4]. Selective internal radioembolization (SIRT) with Yttrium-90 microspheres is an established localablative therapy [5] for intermediate and advanced stages. The radiation can be selectively administrated to the intrahepatic tumors largely avoiding radiation to the normal liver parenchyma [6]. It produces initial average disease control rates above 80% and is usually very well tolerated. When compared to the standard of care for the intermediate and advanced stages, radioembolization consistently provided similar survival rates [7]
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