Abstract No. 528 Bland embolization versus radioembolization for the treatment of HCC in cirrhotic patients: propensity score analysis of the impact on hepatic function

Abstract

Both bland transarterial embolization (TAE) and radioembolization (Y90) for the treatment of HCC have shown similar tumor responses and survival (excluding the radiation segmentectomy approach). While tumor control is a vital outcome, the degree of resulting hepatic impairment is important in this population who often have cirrhosis. The purpose of this study was to analyze the impact of TAE and Y90 on hepatic function based on the MELD score, with propensity score matching to optimally control potential confounders. Analysis was performed on 256 patients undergoing treatment of HCC in a lobar or bilobar fashion with Y90 (n= 100) or TAE (n=156) over a 10-year period. The total bilirubin, creatinine, and INR levels were ascertained immediately pre-procedure and at 1, 6, and 12 months after treatment to calculate MELD scores. Differences in MELD scores were compared using the paired or unpaired t-test and multivariate linear regression. Because confounders may result from selection bias, propensity score matching was performed with the following variables: treatment type, gender, age, unilobar versus bilobar, ECOG, AFP, maximum tumor diameter, viral hepatitis, presence of portal vein invasion, and initial MELD score. The mean baseline pretreatment MELD scores for patients undergoing TAE versus Y90 were 10.7 and 8.9, respectively (p<0.001). After TAE, the MELD score change at 1, 6, and 12 months were 0.8, 1.8, and 2.5 (p=0.036, 0.029, and 0.004), respectively. After Y90, the MELD score change was 2.6, 5.1, and 6.6 (p<0.001 for each). Using the propensity matched cohort, Y90 was associated with a higher change in MELD score at 1, 6, and 12 months (p=0.009, <0.001, and 0.001, respectively). Portal vein invasion was also associated with a higher change in MELD score at 6 months (p=0.004) and 12 months (p=0.04). In a propensity matched cohort of patients treated with lobar or bilobar TAE or Y90, Y90 was associated with significantly higher MELD score changes compared to TAE, and were most pronounced at 12 months. These findings may be important for patient selection and treatment planning, as well as understanding potential impact on liver transplant list status.