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Yttrium-90 Radioembolization for BCLC Stage C Hepatocellular Carcinoma Comparing Child-Pugh A Versus B7 Patients: Are
Qingquan Zu1,2, Ryan C Schenning1, Younes Jahangiri1
1Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA.
Insights
Yttrium-90 (Y90) radioembolization showed significantly worse overall survival for advanced hepatocellular carcinoma patients with Child-Pugh B7 scores compared to Child-Pugh A. Outcomes for B7 patients were similar to B8/9, suggesting cautious patient selection for Y90 radioembolization.
Area of Science:
- Hepatobiliary Medicine
- Interventional Radiology
- Oncology
Background:
- Advanced hepatocellular carcinoma (HCC) presents significant treatment challenges.
- Yttrium-90 (Y90) radioembolization is a treatment option for unresectable HCC.
- Patient selection is crucial for optimizing outcomes in HCC treatment.
Purpose of the Study:
- To evaluate the outcomes of Yttrium-90 (Y90) radioembolization in patients with advanced hepatocellular carcinoma (HCC).
- To compare treatment efficacy across different Child-Pugh score classifications.
- To identify prognostic factors influencing survival after Y90 radioembolization.
Main Methods:
- Retrospective analysis of 106 consecutive patients with BCLC Stage C HCC undergoing Y90 radioembolization.
- Exclusion of patients with additional malignancies, non-liver-related deaths, metastases, or insufficient follow-up data.
- Calculation of overall survival (OS) using Kaplan-Meier method and comparison via log-rank test; Cox regression for prognostic factor evaluation.
Main Results:
- Median OS was 20.2 months for Child-Pugh A, 6.0 months for B7, and 5.5 months for B8/9 (P < 0.001 for B7 vs. A).
- Yttrium-90 (Y90) radioembolization outcomes for Child-Pugh B7 patients were comparable to B8/9 patients.
- Independent predictors of OS included ECOG score, Child-Pugh class, tumor morphology, and Y90 delivery location.
Conclusions:
- Yttrium-90 (Y90) radioembolization outcomes for Child-Pugh B7 patients with advanced HCC are significantly worse than for Child-Pugh A patients.
- Outcomes for Child-Pugh B7 and B8/9 patients were similar, indicating a similar prognosis.
- Results support cautious patient selection for radioembolization in advanced HCC, warranting further research.
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.
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