Abstract No. 534 Radioembolization for infiltrative hepatocellular carcinoma: analysis of 183-patient cohort

Abstract

To study long-term survival and prognostic factors for outcome following radioembolization (Y90) of infiltrative hepatocellular carcinoma (HCC). With IRB approval, we conducted a retrospective chart review (2004-2017) of consecutive patients with infiltrative HCC (non-mass forming tumor) treated with Y90. Baseline staging was performed according to Child-Pugh (CP) and BCLC criteria. The presence and extent of malignant portal vein thrombosis (PVT) or metastases was determined. Overall survival (OS) was estimated by Kaplan-Meier method (median (95% confidence interval [CI])). Univariate analysis was conducted using log-rank test. Multivariate analysis was conducted using Cox-proportional hazards regression. Statistical significance set at p<0.05. 183 patients with infiltrative HCC underwent 294 Y90 treatments. Mean age at Y90 was 64 (range: 42-93) years; 150 (82%) were males. Child-Pugh was A: 72 (39%), B: 104 (57%), C: 7 (4%), respectively. The majority of patients were BCLC C (168 (92%)), with 1 (0.5%), 8 (4%) and 7 (3.5%) BCLC A, B and D patients respectively. 123 (67%) had PVT, 9 had metastases and 30 patients had both. Median OS of the entire cohort was 6.3 (5-7.4) months. When stratifying by CP, median OS (CI) for CP A, CP B and CP C was 9.4 (8-12), 4.4 (3.4-6.2) and 2.5 (2.3-4.5) months, respectively. For patients with neither PVT nor metastases, OS was 10.6 (5-19.4) [CP A: 17 (9-33.4) and CP B: 5 (4.3-11.5) months, respectively]. OS of PVT patients was 6 (CI: 4.5-7.2) months [CP A, B, and C patients had OS (CI) of 8 (7-11.3), 4 (3-5.8), and 2 (2.3-4.4) months, respectively]. OS of patients with segmental PVT was 12 (CI:7-14) months. On univariate analysis, significant prognosticators of OS were CP class (P<0.0001), PVT (P=0.01), extent of PVT (p=0.048), focality (p=0.04) and metastases (p=0.02). On multivariate analysis, CP class, metastases, extent of PVT and tumor focality were significant prognosticators of survival. Patients with infiltrative HCC have a poor prognosis. Those with preserved liver function (CP A), no metastatic disease, and limited (segmental) vascular invasion have survival benefit from Y90.