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Updated: Jul 16, 2026
Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
Tumor Burden Thresholds Associated with Successful Downstaging After Yttrium-90 Radioembolization in Hepatocellular
Chun-Hua Chiu1, Chun-Yen Yu1, Hsin-You Ou1
1Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Purpose:
Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages, limiting access to curative therapies. Yttrium-90 (Y-90) trans-arterial radioembolization (TARE) has been used for tumor downstaging to enable surgical resection or liver transplantation; however, the factors associated with successful downstaging and potential selection thresholds remain unclear.
Patients And Methods:
We retrospectively analyzed 65 patients with unresectable HCC exceeding the University of California, San Francisco (UCSF) criteria who underwent Y-90 TARE between 2020 and 2024. Tumor burden parameters, dosimetric features, treatment response, overall survival (OS), and progression-free survival (PFS) were evaluated. Receiver operating characteristic (ROC) analysis was performed to identify exploratory thresholds associated with successful downstaging, and survival outcomes were assessed using Kaplan-Meier methods.
Results:
Down-staging to within UCSF criteria was achieved in 58.5% of patients. Successfully down-staged patients had significantly longer OS than non-downstaged patients (median OS, not reached vs. 18.8 months; p = 0.034). ROC analysis identified exploratory tumor burden thresholds associated with downstaging failure, including largest tumor diameter ≥7.8 cm, tumor volume ≥265 cm3, and a composite tumor number-diameter score >11. The presence of multiple adverse tumor burden factors was associated with a high likelihood of downstaging failure. When adequate tumor radiation delivery was achieved, a tumor-to-normal uptake ratio (T/N) >4 predicted successful downstaging in tumors <7.8 cm, whereas its prognostic value diminished in larger lesions.
Conclusion:
Y-90 TARE enables effective downstaging in a substantial proportion of patients with advanced HCC and may facilitate subsequent curative surgery or living donor liver transplantation. Tumor burden metrics and size-dependent T/N ratios were associated with successful downstaging and may assist patient selection for Y-90 TARE. These findings should be considered exploratory and warrant validation in larger prospective studies.
