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. 2023 Jun 30;14(3):1378-1391.
doi: 10.21037/jgo-22-882. Epub 2023 May 11.

Long-term outcome analysis of Y90 radioembolization in hepatocellular carcinoma

Hannah M Lee  1 , Laura Alder  2 , Matthew Nguyen  2 , Sean C Dougherty  2 , Yuesheng Qu  2 , Leroy R Thacker  3   4 , Andrew Poklepovic  2   4
Affiliations

Long-term outcome analysis of Y90 radioembolization in hepatocellular carcinoma

Hannah M Lee et al. J Gastrointest Oncol. .

Abstract

Background: Yttrium-90 (Y90) radioembolization is a catheter-based therapy for hepatocellular carcinoma (HCC). Multiple trials have evaluated the efficacy of Y90 in HCC; however, few have assessed long-term hepatic function. This study aimed to evaluate a clinical real-world experience of Y90 effectiveness and long-term impact on hepatic function.

Methods: A single-center retrospective chart review was performed for patients with Child-Pugh (CP) class 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 on the day of treatment and 1, 3, 6, 12, and 24 months post-procedure.

Results: Of the 134 patients included, the mean age was 60 years old and median overall survival (OS) from date of diagnosis was 28 months [95% confidence interval (CI): 22.21-38.05]. Patients with CP class A (85%) had a median progression-free survival (PFS) of 3 months (95% CI: 2.99-5.55) and median OS of 17 months (95% CI: 9.59-23.10) from date of Y90 treatment compared to a median PFS of 4 months (95% CI: 2.07-8.28) and OS of 8 months (95% CI: 4.60-15.64) for patients with CP class B. MELD scores were significantly higher post-treatment than pre-treatment, with significant recovery at 24 months. No significant differences were seen between cancer stage and OS, while PFS and cancer stage did show difference between cancer stage 1 and 3 with longer median PFS seen in stage 1.

Conclusions: While our study supports the literature for OS in Y90-treated patients, we found a shorter PFS in this population. This may reflect the differences between the utilization of RECIST in clinical trials and clinical radiology practice in determining progression. Significant factors associated with OS were age, MELD, CP scores and portal vein thrombosis (PVT). For PFS, CP score and stage at diagnosis were significant. Increasing MELD scores over time likely reflected a combination of radioembolization-induced liver disease, liver decompensation or progression of HCC. The downtrend at 24 months is likely due to long term survivors with significant benefit from therapy with no long-term complications from Y90.

Keywords: Hepatocellular carcinoma (HCC); hepatic function; real-world practice; yttrium-90 (Y90).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-22-882/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
OS (A) and PFS (B) based on AJCC TNM cancer stage. (A) OS does not differ by cancer stage (Wilcoxon , P=0.1660). Since OS did not differ by group, no post-hoc tests were performed. (B) PFS differs by cancer stage (Wilcoxon , P=0.0010). Post-hoc comparisons using a Bonferroni adjust to P values for multiple comparisons indicates that stage 3 is significant different from stage 1 (adjusted P=0.0036) but no other groups differences reach statistical significance after adjustment. OS, overall survival; PFS, progression-free survival; AJCC, American Joint Committee of Cancer.
Figure 2
Figure 2
OS and PFS based on PVT and MELD-NA post Y90. (A) OS by PVT history. OS of 17 months [95% CI: 10.54–23.10; mean survival 23.02 (1.89) months] from date of Y90 compared to a median of 7 months [95% CI: 4.50–9.89; mean survival 11.60 (2.27) months] for patients with presence of PVT. This difference was statistically significant by both the log-rank (χ2=6.48, P=0.0109) and the Wilcoxon (χ2=8.37, P=0.0038) tests. (B) PFS by PVT history. Patients with no PVT had a median PFS of 4 months [95% CI: 3.19–6.67; mean survival 8.75 (1.00) months] from date of Y90 compared to a median of 3 months [95% CI: 2.14–3.29; mean survival 4.05 (0.74) months] for patients with a history of PVT. This difference was statistically significant by both the Log-Rank (χ2=8.33, P=0.0039) and the Wilcoxon (χ2=5.33, P=0.0210) tests. (C) MELD-NA over time after Y90. (D) MELD-NA over time after Y90 by long-term (OS 12 or more months) vs. short-term survival. OS, overall survival; PFS, progression-free survival; PVT, portal vein thrombosis; MELD-NA, model for end-stage liver disease-sodium; Trt, treatment.
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References

    1. Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma. Lancet 2022;400:1345-62. 10.1016/S0140-6736(22)01200-4 - DOI - PubMed
    1. McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of Hepatocellular Carcinoma. Hepatology 2021;73 Suppl 1:4-13. 10.1002/hep.31288 - DOI - PMC - PubMed
    1. National Program of Cancer Registries. Cancer Surveillance System (NPCR-CSS), Centers for Disease Control and Prevention. Available online: https://www.cdc.gov/cancer/npcr/index.htm
    1. National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. Available online: https://seer.cancer.gov
    1. Kim E, Viatour P. Hepatocellular carcinoma: old friends and new tricks. Exp Mol Med 2020;52:1898-907. 10.1038/s12276-020-00527-1 - DOI - PMC - PubMed