Abstract
Yttrium-90 transarterial radioembolization (TARE) has shown promising efficacy in the treatment of patients with hepatocellular carcinoma (HCC), associated with portal vein tumor thrombus (PVTT). The aim of this study is to identify prognostic factors for survival in patients with HCC and PVTT undergoing TARE, and build a prognostic classification for these patients. This is a single center retrospective study conducted over six years (2010-2015), on consecutive patients undergoing TARE. Patients were included if they met the following criteria: presence of at least one measurable HCC, presence of PVTT not occluding the main portal trunk, absence of extrahepatic metastases, Child-Pugh score within B7, Eastern Cooperative Oncology Group performance status 0-1. Uni- and multivariable analysis was used to explore the variables that showed an independent relationship with survival. A prognostic score was then derived, and three prognostic categories were identified. A total of 120 patients were included in the study. Median overall survival (OS) was 14.1 months (95% CI 10.7-17.5) and median progression-free survival (PFS) was 6.5 months (95% CI 3.8-9.2). The only variables independently correlated with OS were bilirubin, extension of PVTT and tumor burden. Three prognostic categories were identified: favourable prognosis (0 points), intermediate prognosis (2-3 points) and dismal prognosis (>3 points). Median OS in the three categories was 32.2 months, 14.9 months and 7.8 months respectively (p <0.0001). PFS (p = 0.045) and the risk of liver decompensation (p <0.0001) also significantly differed along the same prognostic categories. Radioembolization with Yttrium-90 is an effective therapy for patients with HCC and PVTT. The proposed prognostic stratification may help to better identify good candidates for the treatment, and those for whom TARE may be futile. Yttrium-90 transarterial radioembolization (TARE) is a microembolic procedure that minimizes alterations to hepatic arterial flow, and thus can be safely performed in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). In this study, we retrospectively evaluated the independent predictors of long-term outcomes in patients with HCC and PVTT treated with TARE. Bilirubin level, extension of PVTT and tumor burden were independently related to post-treatment survival: the combination of these factors allowed us to build a prognostic stratification that may help to better identify good candidates for the treatment, and those for whom TARE may be futile.
Highlights
Hepatocellular carcinoma (HCC) is a global health problem and one of the leading causes of cancer-related death especially in cirrhotic patients(1, 2)
We retrospectively evaluated the independent predictors of long-term outcomes in patients with hepatocellular carcinoma (HCC) and PVTT treated with trans-arterial radioembolization (TARE)
Aim of this study is to identify, in a prospectively collected series of patients with PVTT treated with TARE, the prognostic factors with relevant impact on patients’ survival, in order to build a prognostic classification that may allow to identify patients who would benefit most from the treatment
Summary
Hepatocellular carcinoma (HCC) is a global health problem and one of the leading causes of cancer-related death especially in cirrhotic patients(1, 2). A substantial proportion of patients still present tumoral portal vein thrombosis (PVTT) either at onset of the disease or as result of HCC recurrence or progression, leading to an advanced stage of the disease not amenable to curative treatments(4). Two pivotal phase III trials have demonstrated a survival advantage for patients with advanced HCC treated with the oral multi-tyrosine kinase inhibitor sorafenib(7, 8) with respect to placebo, and a subgroup analysis has confirmed this result in patients with PVTT(9, 10). Sustained responses to sorafenib are rare, median survival in patients with advanced HCC remains limited to 6.5 - 10.7 months, and the treatment itself is associated with side effects that frequently lead to early treatment interruption(7, 8, 13, 14). Yttrium-90 trans-arterial radioembolization (TARE) has shown promising efficacy in the treatment of patients with hepatocellular carcinoma (HCC) associated with tumoral portal vein thrombosis (PVTT). Aim of this study is to identify prognostic factors for survival in patients with HCC and PVTT undergoing TARE, and build a prognostic classification for these patients
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