May 1, 2020
Study Suggests Need for Cautious Patient Selection to Treat HCC With Y-90 Radioembolization
May 1, 2020—Findings from an evaluation of yttrium-90 (Y-90) radioembolization outcomes across Child-Pugh scores in patients with advanced hepatocellular carcinoma (HCC), per the Barcelona Clinic Liver Cancer (BCLC) staging system, were published by Qingquan Zu, MD, et al in CardioVascular and Interventional Radiology (CVIR; 2020;43:721–731).
The study showed that outcomes from Y-90 for BCLC stage C HCC for Child-Pugh B7 patients were equivalent to B8/9 patients and significantly worse compared with Child-Pugh A patients. “Although further research is warranted, these results suggest continued cautious patient selection for radioembolization in advanced HCC,” concluded the investigators in CVIR.
The study retrospectively analyzed 91 of 106 consecutive patients with BCLC stage C HCC who underwent Y-90 radioembolization from April 2005 to December 2018. Fifteen patients were excluded because of additional malignancy (n = 7), death unrelated to liver disease (n = 2), metastases (n = 2), or lack of follow-up data (n = 4). Overall survival 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.
As summarized in CVIR, the mean age was 63 years, and 85.7% were male. Hepatitis C virus 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.
The investigators found median overall after radioembolization was:
- Child-Pugh A, 20.2 months (95% confidence interval [CI], 13–27.4)
- Child-Pugh B7, 6 months (95% CI, 4.4–7.6; P < .001 for B7 vs A)
- Child-Pugh B8/9, 5.5 months (95% CI, 2.5–8.5; P = .537 for B7 vs B8/9)
Additionally, multivariable Cox regression analysis showed that the Eastern Cooperative Oncology Group score (P < .001), Child-Pugh class (P = .005), tumor morphology pattern (P = .012), and Y-90 delivery location (P = .02) were significant independent predictors of overall survival, reported the investigator in CVIR.