Survival Analysis of Advanced HCC Treated with Radioembolization: Comparing Impact of Clinical Performance Status Versus Vascular Invasion/Metastases.

Abstract

PURPOSE:

In this study, we aim to compare the effects of prognostic indicators on survival analysis for Barcelona Clinic Liver Cancer (BCLC) C patients undergoing yttrium-90 radioembolization (Y-90).

METHODS:

A prospectively acquired database (2003-2017) for BCLC C hepatocellular carcinoma (HCC) patients that underwent radioembolization with Y-90 was searched. The criteria for BCLC C status (Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 1 or 2, metastases, and/or portal vein thrombosis (PVT)) were recorded. Kaplan-Meier survival analyses were performed from the date of the first radioembolization with Y-90, censored to curative treatment, to determine median overall survival (OS). Cox regression hazards model was used for multivariate analyses. Significance was set at P < 0.05.

RESULTS:

547 BCLC C patients treated with radioembolization with Y-90 had a median OS of 10.7 months (range: 9.5-12.9). 43% (233 of 547) patients classified as BCLC C solely by their ECOG PS had a median OS of 19.4 months (14.7-23.7); 57% (314 of 547) patients with PVT/metastases had a median OS of 7.7 months (6.7-8.7). On multivariate analysis, ECOG PS was not found to be a statistically significant prognostic indicator of OS in BCLC C whereas metastases and PVT exhibited hazards ratios (95%CI) of 0.51 (0.38-0.69) and 0.49 (0.38-0.63), respectively (P < 0.0001).

CONCLUSION:

Patients classified as BCLC C due to ECOG PS 1 demonstrated longer survival when compared to those presenting with PVT, metastases and/or ECOG PS 2. Hence, ECOG PS 1, as an isolated variable, may not be a true indicator of advanced disease.

• Authors: Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ronald A Mora, Laura Kulik, Michael Abecassis, Ahsun Riaz, Riad Salem, Robert J Lewandowski
• Journal: Cardiovascular and interventional radiology (Cardiovasc Intervent Radiol) Vol. 41 Issue 2 Pg. 260-269 (Feb 2018) ISSN: 1432-086X [Electronic] United States
• PMID: 28879621 (Publication Type: Journal Article)

Chemical References

• Yttrium Radioisotopes
• Yttrium-90

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular (mortality, pathology, therapy)
• Embolization, Therapeutic
• Female
• Follow-Up Studies
• Humans
• Liver Neoplasms (mortality, pathology, therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Invasiveness (pathology)
• Neoplastic Cells, Circulating (pathology)
• Prognosis
• Survival Analysis
• Yttrium Radioisotopes (therapeutic use)