Health-related quality of life in unresectable hepatocellular carcinoma (HCC) in patients treated with TACE or 90-Yttrium

Abstract

8149 Background: Nonsurgical treatment options for unresectable HCC are limited and have modest survival benefits. As a result, health related quality of life (HRQL) has become essential when testing new therapies. The aims of the present study were to test differences in HRQL in HCC patients (pts) treated with 90-Yttrium or transarterial chemoembolization (TACE). Methods: In this prospective, nonrandomized study, 127 pts with biopsy-proven, unresectable HCC, and a prognosis greater than 3 months (mos), were recruited for participation. 79 pts were treated with TACE and 48 pts with 90-Yttrium. HRQL was assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary at diagnosis, 3-, 6-, and 12 mos or until death. Survival was measured in months from diagnosis till death. Results: Using Analyses of Variance (ANOVA), pts referred for treatment with TACE had significantly larger mean tumor size, vascular invasion, and higher bilirubin, WBC, GGTP, and PT at baseline. Using repeated measures Analysis of Covariance (ANCOVA), covarying for significant differences in disease-specific variables at diagnosis, pts treated with 90-Yttrium reported a better functional well-being [F(1,40)=5.7, p=0.02] and overall quality of life [F(1,38)=4.6, p=0.04] at 3-mos follow-up. Pts in both treatment groups reported significant improvement in emotional well-being at 3-mos follow-up [F(1,20)=5.4, p=0.03]. No significant differences in HRQL were observed at 6- or 12-mos follow-up. Conclusions: Treatment of unresectable HCC with Yttrium-90 resulted in better functional well-being and overall HRQL at 3-mos follow-up compared to pts treated with TACE, while covarying for disease-specific differences at diagnosis. It is likely that no differences in HRQL were observed at 6- and 12-months follow-up secondary the high rates of death in pts treated with TACE, compared to 90-Yttrium, at 6-mos (60% vs 40%) and 12-mos (85% vs 65%) and as a result, high levels of attrition in assessment of HRQL were observed due to severe illness and death at 6-mos (N=10 vs 16) and 12-mos follow-up (N=2 vs 7). A randomized control trial assessing HRQL and survival benefits of 90-Yttrium is warranted. No significant financial relationships to disclose.