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Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma. Can J Gastroenterol Hepatol 2021;2021:9926704

Date

08/03/2021

Pubmed ID

34336728

Pubmed Central ID

PMC8324378

DOI

10.1155/2021/9926704

Scopus ID

2-s2.0-85112482482 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

PURPOSE: This study aims to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) in patients undergoing Yttrium-90 radioembolization (Y90-RE) for hepatocellular carcinoma (HCC).

METHODS: Retrospectively, patients with Y90-RE naïve HCC who were candidates or potential candidates for LT and underwent Y90-RE were included. Patients were then divided into favorable (maintained or achieved Milan criteria (MC) eligibility) or unfavorable (lost eligibility or unchanged MC ineligibility) cohorts based on changes to their MC eligibility after Y90-RE. Penalized logistic regression analysis was performed to identify the significant baseline prognosticators.

RESULTS: Between 2013 and 2018, 135 patients underwent Y90-RE treatment. Among the 59 (42%) patients within MC, LT eligibility was maintained in 49 (83%) and lost in 10 (17%) patients. Within the 76 (56%) patients outside MC, eligibility was achieved in 32 (42%) and unchanged in 44 (58%). Among the 81 (60%) patients with a favorable response, 16 (20%) went on to receive LT. Analysis of the baseline characteristics revealed that lower Albumin-Bilirubin score, lower Child-Pugh class, lower Barcelona Clinic Liver Cancer stage, HCC diagnosis using dynamic contrast-enhanced imaging on CT or MRI, normal/higher albumin levels, decreased severity of tumor burden, left lobe HCC disease, and absence of HBV-associated cirrhosis, baseline abdominal pain, or fatigue were all associated with a higher likelihood of bridging or downstaging to LT eligibility (p's < 0.05).

CONCLUSION: Certain baseline clinical and tumor characteristics are associated with the successful bridging or downstaging of potential LT candidates with HCC undergoing Y90-RE.

Author List

Villalobos A, Wagstaff W, Guo M, Zhang J, Bercu Z, Whitmore MJ, Cristescu MM, Majdalany BS, Wedd J, Akce M, Magliocca J, Kokabi N

Author

Mircea M. Cristescu MD, MBA Assistant Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Carcinoma, Hepatocellular
Humans
Liver Neoplasms
Retrospective Studies
Treatment Outcome
Yttrium Radioisotopes