Abstract
Liver-directed therapies for unresectable hepatocellular carcinoma (HCC) patients with advanced disease [Barcelona Clinic for Liver Cancer (BCLC) C] are increasingly employed. In this study, we aim to study the efficacy and prognostic indicators for BCLC C patients undergoing yttrium-90 radioembolization (Y90). With IRB approval, we searched our prospectively acquired database and included all BCLC C HCC patients that underwent Y90. The indication for BCLC C status [Eastern Cooperative Oncology Group (ECOG) performance status of 1 or 2, metastases, and/or portal vein thrombosis (PVT)] was recorded. Kaplan-Meier survival analyses were performed from the date of first Y90, censored to curative treatment, to calculate median overall survival (OS). Cox regression hazards model was used for multivariate analyses. Significance was set at P<0.05. 515 BCLC C patients were treated with Y90 with a median survival of 10.6 months (95% CI: 9.3-12.8). 189 patients (36.7%) were classified as BCLC C solely by their ECOG performance status; they had a median survival (95% CI) of 19.6 months (14.7-27). 326 patients (63.3%) were classified as BCLC C due to vascular invasion or metastases (regardless of ECOG performance status); they had an OS of 8 months (95% CI: 7.3-9) (P = 0.001). On multivariate analysis, ECOG was not found to be a statistically significant prognostic indicator of survival in BCLC C patients whereas metastasis and PVT had hazards ratios (95%CI) of 2.4 (1.8-3.1) and 3.2 (2.6-3.8), respectively (P<0.001). Radioembolization is an effective method of treating BCLC C HCC patients with median OS similar to that realized with currently allocated therapy per BCLC guidelines. Patients classified as BCLC C due to ECOG performance status alone demonstrated improved survival when compared to those presenting with PVT and/or metastases, regardless of ECOG. Hence, ECOG performance status by itself may not be a true indicator of advanced disease.
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