TY - JOUR
T1 - Yttrium-90 Radioembolization for BCLC Stage C Hepatocellular Carcinoma Comparing Child–Pugh A Versus B7 Patients
T2 - Are the Outcomes Equivalent?
AU - Zu, Qingquan
AU - Schenning, Ryan C.
AU - Jahangiri, Younes
AU - Tomozawa, Yuki
AU - Kolbeck, Kenneth J.
AU - Kaufman, John A.
AU - Al-Hakim, Ramsey
AU - Naugler, Wilscott E.
AU - Nabavizadeh, Nima
AU - Kardosh, Adel
AU - Billingsley, Kevin
AU - Mayo, Skye C.
AU - Orloff, Susan L.
AU - Enestvedt, Kristian K.
AU - Maynard, Erin
AU - Ahn, Joseph
AU - Lhewa, Dekey
AU - Farsad, Khashayar
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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.
AB - 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.
KW - Child–Pugh
KW - Hepatocellular carcinoma
KW - Outcomes
KW - Radioembolization
KW - Yttrium-90
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U2 - 10.1007/s00270-020-02434-4
DO - 10.1007/s00270-020-02434-4
M3 - Article
C2 - 32140840
AN - SCOPUS:85081567576
SN - 0174-1551
VL - 43
SP - 721
EP - 731
JO - Cardiovascular and interventional radiology
JF - Cardiovascular and interventional radiology
IS - 5
ER -