Long-term outcome analysis of Y90 radioembolization in hepatocellular carcinoma.

Abstract

e16633 Background: Yttrium-90 (Y90) radioembolization is a catheter-based therapy utilized in the treatment of hepatic tumors such as hepatocellular carcinoma (HCC). Multiple trials have evaluated the efficacy of Y90 in HCC; few have assessed long term hepatic function. These studies reported PFS ranging from 7.9 to 18 months (m), and median OS of 17.2 to 18 m for Child-Pugh (CP) Class A and 6.0 to 7.7 m for CP Class B. This study aimed to evaluate a clinical real-world experience of Y90 therapeutic effectiveness and long-term impact on hepatic function. Methods: A single-center retrospective chart review was performed for patients with a CP score of A or B who received Y90 for primary HCC between 2008 and 2016. Model for end stage liver disease (MELD) and CP scores were calculated for the day of treatment and at 1, 3, 6, 12, and 24 m post procedure. OS and PFS were characterized using a Kaplan-Meier survival analysis and a multivariate model. Results: 134 patients were included. Mean age was 60 years old, ranging from 44-90. Underlying liver disease included HCV – 66%, ETOH cirrhosis – 23%, NAFLD – 19%, HBV – 5%. CP Class A patients (79%) had a median OS of 16.59 m (95% CI: 8.90 to 23.10m) from date of Y90 treatment compared to a median of 7.90 m (95% CI: 4.60 to 15.64 m) for CP Class B. CP Class A patients had a median PFS of 3.45 m (95% CI: 2.99 to 5.55 m) from date of Y90 treatment compared to a median of 3.71 m (95% CI: 2.07 to 8.28 m) for CP Class B patients. These differences were not statistically significant. Median OS from date of diagnosis for the entire study population was 29.37 m (95% CI: 23.00 to 38.77 m). MELD scores were statistically significantly higher at 1, 3, 6 and 12 m post-treatment than on Day 0, with significant recovery at 24 vs 3 m. Older age, higher T stage, higher MELD and CP scores, and patients with a history of portal vein thrombosis (PVT) had significantly lower OS. PFS was significantly shorter in those with advanced stage at diagnosis and higher CP score. Conclusions: While our study supports the literature for OS in Y90 patients, we found a shorter PFS in this population. This may reflect the utilization of RECIST in clinical trials vs clinical radiology practice in determining progression. Over time, the most significant factors associated with OS were age, MELD and CP scores and PVT. For PFS, CP score and stage at diagnosis were significant. The increasing MELD and CP scores over time reflect a possible mix of radio embolization‐induced liver disease and progression of HCC. The downtrend at 24 m is likely due to durable survivors with significant benefit from therapy and no long-term complications from Y90.