Viral hepatitis associated hepatocellular carcinoma outcomes with Y-90 radioembolization.

Abstract

414 Background: Viral associated malignancies have been shown to have improved outcomes. We sought to evaluate outcomes of patients with and without viral hepatitis (HBV and HCV) treated with lobar yttrium-90 radioembolization (RE) for multifocal, unresectable hepatocellular carcinoma (HCC). Methods: After IRB approval, an institutional database of patients with HCC who received RE between 2009-2015 was queried and 99 patients were identified that received a total of 122 lobar RE. Charts were reviewed to capture previous treatments, α-fetoprotein values (AFP), Child-Pugh class (CP), albumin-bilirubin score (ALBI), portal vein thrombosis (PVT), volumes treated and doses delivered. Comparison was made with Chi-Square and Mann-U Whitney when appropriate. Intrahepatic control (IHC), extrahepatic control (EHC), progression free survival (PFS), and overall survival (OS) were calculated according to the Kaplan-Meier method via log-rank. Hazard ratios were calculated using Cox regression. Results: Median follow up for viral hepatitis and non-viral hepatitis patients was 10.9 months (range 0.8-46.7 months) and 11.8 months (range 1.1-62.8 months), respectively. Patients with viral hepatitis associated HCC (n = 44) were younger and had smaller liver volumes; however there was no difference with respect to gender, pre-treatment AFP, CP, ALBI, PVT, extrahepatic disease, previous treatments, and dose given. Median dose for viral hepatitis and non-viral hepatitis patients was 129.5 Gy (range 90-215.8 Gy) and 131 Gy (range 100.9-265 Gy), respectively. 1 year IHC was 67% for viral associated HCC versus 34% for non-viral HCC (p = 0.067). 1 year EHC was 63% for viral associated HCC versus 86% for non-viral HCC (p = 0.027). 1 year PFS was 45% for viral associated HCC versus 31% for non-viral HCC (p = 0.56). 1 year OS was 46% for viral associated HCC versus 55% for non-viral patients (p = 0.55). On MVA, patients that received salvage treatments, CP A, no PVT, and without extrahepatic disease had improved OS. Conclusions: Patients with viral hepatitis associated HCC had improved IHC and significantly worse EHC. Consideration should be made for systemic therapy following Y-90 embolization in patients with viral hepatitis associated HCC.