Abstract
Purpose This study aims to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) in patients undergoing Yttrium-90 radioembolization (Y90-RE) for hepatocellular carcinoma (HCC). Methods Retrospectively, patients with Y90-RE naïve HCC who were candidates or potential candidates for LT and underwent Y90-RE were included. Patients were then divided into favorable (maintained or achieved Milan criteria (MC) eligibility) or unfavorable (lost eligibility or unchanged MC ineligibility) cohorts based on changes to their MC eligibility after Y90-RE. Penalized logistic regression analysis was performed to identify the significant baseline prognosticators. Results Between 2013 and 2018, 135 patients underwent Y90-RE treatment. Among the 59 (42%) patients within MC, LT eligibility was maintained in 49 (83%) and lost in 10 (17%) patients. Within the 76 (56%) patients outside MC, eligibility was achieved in 32 (42%) and unchanged in 44 (58%). Among the 81 (60%) patients with a favorable response, 16 (20%) went on to receive LT. Analysis of the baseline characteristics revealed that lower Albumin-Bilirubin score, lower Child–Pugh class, lower Barcelona Clinic Liver Cancer stage, HCC diagnosis using dynamic contrast-enhanced imaging on CT or MRI, normal/higher albumin levels, decreased severity of tumor burden, left lobe HCC disease, and absence of HBV-associated cirrhosis, baseline abdominal pain, or fatigue were all associated with a higher likelihood of bridging or downstaging to LT eligibility (p's < 0.05). Conclusion Certain baseline clinical and tumor characteristics are associated with the successful bridging or downstaging of potential LT candidates with HCC undergoing Y90-RE.
Highlights
Liver cancer remains the fourth leading cause of malignancy-related mortality worldwide [1], with a 5-year survival of 15% and a lethality profile second only to pancreatic cancer [2]
Recently has the use of Yttrium-90 radioembolization (Y90-RE) been evaluated for the purposes of providing bridging or downstaging therapy [7,8,9]. In light of these contemporary changes, the aim of this study was to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) candidacy, as defined by Milan criteria (MC), in patients with hepatocellular carcinoma (HCC) undergoing Y90-RE therapy
While it has been previously reported that worsening hepatic function can occur after Y90RE irrespective of the Barcelona Clinic Liver Cancer (BCLC) stage [13,14], recent literature has found that most incidences of post-Y90-RE hepatic dysfunction are self-limited and of minimal to no clinical significance [15]
Summary
Liver cancer remains the fourth leading cause of malignancy-related mortality worldwide [1], with a 5-year survival of 15% and a lethality profile second only to pancreatic cancer [2]. E opportunity for a patient to attain LT is limited, especially for those residing in geographical regions where donor organ shortages exist or for those with tumors outside accepted transplant candidacy criteria [3]. To address this challenge, many transplant centers have embraced bridging or downstaging therapies, which are, respectively, aimed at Canadian Journal of Gastroenterology and Hepatology ameliorating tumor progression or reducing tumor burden [4]. In light of these contemporary changes, the aim of this study was to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to LT candidacy, as defined by Milan criteria (MC), in patients with HCC undergoing Y90-RE therapy
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