Yttrium-90 Radioembolization for BCLC Stage C Hepatocellular Carcinoma Comparing Child–Pugh A Versus B7 Patients: Are the Outcomes Equivalent?

• Published in: Cardiovascular and interventional radiology Vol. 43; no. 5; pp. 721 - 731
• Main Authors: Zu, Qingquan, Schenning, Ryan C., Jahangiri, Younes, Tomozawa, Yuki, Kolbeck, Kenneth J., Kaufman, John A., Al-Hakim, Ramsey, Naugler, Wilscott E., Nabavizadeh, Nima, Kardosh, Adel, Billingsley, Kevin G., Mayo, Skye C., Orloff, Susan L., Enestvedt, Kristian K., Maynard, Erin, Ahn, Joseph, Lhewa, Dekey, Farsad, Khashayar
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2020; Springer Nature B.V
• Subjects: Cardiology; Clinical Investigation; Etiology; Hepatocellular carcinoma; Imaging; Interventional Oncology; Liver cancer; Liver diseases; Malignancy; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Nuclear Medicine; Oncology; Radiology; Survival; Ultrasound; Yttrium; Hepatocellular carcinoma; Radioembolization; Child–Pugh; Yttrium-90; Outcomes
• ISSN: 0174-1551; 1432-086X; 1432-086X
• DOI: 10.1007/s00270-020-02434-4

Objective To evaluate yttrium-90 (Y90) radioembolization outcomes across Child–Pugh scores in patients with advanced hepatocellular carcinoma (HCC). Materials and Methods From April 2005 to December 2018, 106 consecutive patients with BCLC Stage C HCC who underwent Y90 radioembolization were retrospectively analyzed. Exclusion criteria included additional malignancy ( n  = 7), death unrelated to liver disease ( n  = 2), metastases ( n  = 2), or lack of follow-up data ( n  = 4). Ninety-one patients were analyzed. Overall survival (OS) was calculated using the Kaplan–Meier method and compared between groups with the log-rank test. Cox regression modeling was used to evaluate the prognostic factors for survival. Results Mean age was 63 years and 85.7% were male. HCV infection was the most common etiology of liver disease (58.2%). Sixty-four (70.3%) patients were Child–Pugh A, 19 (20.9%) patients were B7, and eight (8.8%) patients were B8–9. Median OS after radioembolization was 20.2 [95% confidence interval (CI) 13.0–27.4], 6.0 (95% CI 4.4–7.6), and 5.5 (95% CI 2.5–8.5) months for Child–Pugh A, B7, and B8/9 groups, respectively ( P  < 0.001 for B7 vs. A; P  = 0.537 for B7 vs. B8/9). The multivariable Cox regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score ( P  < 0.001), Child–Pugh class ( P  = 0.005), tumor morphology pattern ( P  = 0.012), and Y90 delivery location ( P  = 0.020) were significant independent predictors of overall survival. Conclusions Outcomes from Y90 for BCLC C HCC for Child–Pugh B7 patients were equivalent to B8/9 patients and significantly worse compared to Child–Pugh A patients. Although further research is warranted, these results suggest continued cautious patient selection for radioembolization in advanced HCC.