90 Y radioembolization for locally advanced hepatocellular carcinoma with portal vein thrombosis: Long-term outcomes in a 185-patient cohort

Nadine Abouchaleh, Ahmed Gabr, Rehan Ali, Ali Al Asadi, Ronald A. Mora, Joseph Ralph Kallini, Samdeep K Mouli, Ahsun Riaz, Robert J Lewandowski, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

We report survival outcomes for patients with advanced-stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with 90 Y radioembolization. Methods: With institutional review board approval, we searched our prospectively acquired database for 90 Y patients treated between 2003 and 2017. Inclusion criteria were patients who had HCC with tumor PVT. Patients with metastases were excluded. Laboratory data were collected at baseline and 1 mo after 90 Y radioembolization. Toxicity grades were reported according to the Common Terminology Criteria for Adverse Events, version 4.0, and long-term survival outcomes were reported and stratified by Child-Pugh class (CP). Overall survival was calculated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. A subanalysis for patients with a high level of α-fetoprotein (AFP) (.100 ng/dL) was conducted. Results: In total, 185 patients with HCC PVT underwent 90 Y radioembolization. Seventy-four (40%) were CP-A, 51 (28%) were CP-B7, and 60 (32%) were ≥CP-B8. New albumin, bilirubin, and alkaline phosphatase grade 3/4 toxicities were, respectively, 3%, 10%, and 0% for CP-A; 14%, 12%, and 6% for CP-B7; and 23%, 32%, and 3% for ≥CP-B8. Median overall survival for CP-A patients was 13.3 mo (95% confidence interval [CI], 8.7-15.7 mo). CP-B7 and ≥CP-B8 patients exhibited median overall survival of 6.9 mo (95% CI, 5.3-10.1 mo) and 3.9 mo (95% CI, 2.9-5.0 mo), respectively. Significant overall survival prognosticators on univariate analysis were albumin, bilirubin, ascites, tumor size 5 cm or smaller, focality, distribution, infiltration, Eastern Cooperative Oncology Group status, AFP level, and PVT extent. Multivariate analysis showed the prognosticators of overall survival to be bilirubin, no ascites, tumor size 5 cm or smaller, solitary lesion, baseline AFP level lower than 100 ng/dL, and Eastern Cooperative Oncology Group status. Of 123 patients with a high AFP level (.100 ng/dL), 12 patients achieved restored normal AFP levels (,13 ng/dL) and exhibited median overall survival of 23.9 mo (95% CI, 20.1-124.1 mo). AFP responders at 1 mo had better overall survival than nonresponders, at 8.5 mo versus 4.8 mo (P 5 0.018); AFP responders at 3 mo had overall survival of 13.3 mo, versus 6.9 mo for nonresponders (P 5 0.021). Conclusion: 90 Y radioembolization can serve as a safe and effective treatment for advanced-stage HCC patients with tumor PVT. Overall survival outcomes are affected by baseline liver function, tumor size, and AFP level.

Original languageEnglish (US)
Pages (from-to)1042-1048
Number of pages7
JournalJournal of Nuclear Medicine
Volume59
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Portal Vein
Hepatocellular Carcinoma
Thrombosis
Survival
Bilirubin
Confidence Intervals
Neoplasms
Ascites
Albumins
Multivariate Analysis
Fetal Proteins
Research Ethics Committees
Terminology
Alkaline Phosphatase
Databases
Neoplasm Metastasis
Liver

Keywords

  • Hepatocellular carcinoma (HCC)
  • Portal vein thrombosis (PVT)
  • Y radioembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{0ec71958a746481e8424055fdb561d83,
title = "90 Y radioembolization for locally advanced hepatocellular carcinoma with portal vein thrombosis: Long-term outcomes in a 185-patient cohort",
abstract = "We report survival outcomes for patients with advanced-stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with 90 Y radioembolization. Methods: With institutional review board approval, we searched our prospectively acquired database for 90 Y patients treated between 2003 and 2017. Inclusion criteria were patients who had HCC with tumor PVT. Patients with metastases were excluded. Laboratory data were collected at baseline and 1 mo after 90 Y radioembolization. Toxicity grades were reported according to the Common Terminology Criteria for Adverse Events, version 4.0, and long-term survival outcomes were reported and stratified by Child-Pugh class (CP). Overall survival was calculated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. A subanalysis for patients with a high level of α-fetoprotein (AFP) (.100 ng/dL) was conducted. Results: In total, 185 patients with HCC PVT underwent 90 Y radioembolization. Seventy-four (40{\%}) were CP-A, 51 (28{\%}) were CP-B7, and 60 (32{\%}) were ≥CP-B8. New albumin, bilirubin, and alkaline phosphatase grade 3/4 toxicities were, respectively, 3{\%}, 10{\%}, and 0{\%} for CP-A; 14{\%}, 12{\%}, and 6{\%} for CP-B7; and 23{\%}, 32{\%}, and 3{\%} for ≥CP-B8. Median overall survival for CP-A patients was 13.3 mo (95{\%} confidence interval [CI], 8.7-15.7 mo). CP-B7 and ≥CP-B8 patients exhibited median overall survival of 6.9 mo (95{\%} CI, 5.3-10.1 mo) and 3.9 mo (95{\%} CI, 2.9-5.0 mo), respectively. Significant overall survival prognosticators on univariate analysis were albumin, bilirubin, ascites, tumor size 5 cm or smaller, focality, distribution, infiltration, Eastern Cooperative Oncology Group status, AFP level, and PVT extent. Multivariate analysis showed the prognosticators of overall survival to be bilirubin, no ascites, tumor size 5 cm or smaller, solitary lesion, baseline AFP level lower than 100 ng/dL, and Eastern Cooperative Oncology Group status. Of 123 patients with a high AFP level (.100 ng/dL), 12 patients achieved restored normal AFP levels (,13 ng/dL) and exhibited median overall survival of 23.9 mo (95{\%} CI, 20.1-124.1 mo). AFP responders at 1 mo had better overall survival than nonresponders, at 8.5 mo versus 4.8 mo (P 5 0.018); AFP responders at 3 mo had overall survival of 13.3 mo, versus 6.9 mo for nonresponders (P 5 0.021). Conclusion: 90 Y radioembolization can serve as a safe and effective treatment for advanced-stage HCC patients with tumor PVT. Overall survival outcomes are affected by baseline liver function, tumor size, and AFP level.",
keywords = "Hepatocellular carcinoma (HCC), Portal vein thrombosis (PVT), Y radioembolization",
author = "Nadine Abouchaleh and Ahmed Gabr and Rehan Ali and Asadi, {Ali Al} and Mora, {Ronald A.} and Kallini, {Joseph Ralph} and Mouli, {Samdeep K} and Ahsun Riaz and Lewandowski, {Robert J} and Riad Salem",
year = "2018",
month = "7",
day = "1",
doi = "10.2967/jnumed.117.199752",
language = "English (US)",
volume = "59",
pages = "1042--1048",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "7",

}

90 Y radioembolization for locally advanced hepatocellular carcinoma with portal vein thrombosis : Long-term outcomes in a 185-patient cohort. / Abouchaleh, Nadine; Gabr, Ahmed; Ali, Rehan; Asadi, Ali Al; Mora, Ronald A.; Kallini, Joseph Ralph; Mouli, Samdeep K; Riaz, Ahsun; Lewandowski, Robert J; Salem, Riad.

In: Journal of Nuclear Medicine, Vol. 59, No. 7, 01.07.2018, p. 1042-1048.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 90 Y radioembolization for locally advanced hepatocellular carcinoma with portal vein thrombosis

T2 - Long-term outcomes in a 185-patient cohort

AU - Abouchaleh, Nadine

AU - Gabr, Ahmed

AU - Ali, Rehan

AU - Asadi, Ali Al

AU - Mora, Ronald A.

AU - Kallini, Joseph Ralph

AU - Mouli, Samdeep K

AU - Riaz, Ahsun

AU - Lewandowski, Robert J

AU - Salem, Riad

PY - 2018/7/1

Y1 - 2018/7/1

N2 - We report survival outcomes for patients with advanced-stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with 90 Y radioembolization. Methods: With institutional review board approval, we searched our prospectively acquired database for 90 Y patients treated between 2003 and 2017. Inclusion criteria were patients who had HCC with tumor PVT. Patients with metastases were excluded. Laboratory data were collected at baseline and 1 mo after 90 Y radioembolization. Toxicity grades were reported according to the Common Terminology Criteria for Adverse Events, version 4.0, and long-term survival outcomes were reported and stratified by Child-Pugh class (CP). Overall survival was calculated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. A subanalysis for patients with a high level of α-fetoprotein (AFP) (.100 ng/dL) was conducted. Results: In total, 185 patients with HCC PVT underwent 90 Y radioembolization. Seventy-four (40%) were CP-A, 51 (28%) were CP-B7, and 60 (32%) were ≥CP-B8. New albumin, bilirubin, and alkaline phosphatase grade 3/4 toxicities were, respectively, 3%, 10%, and 0% for CP-A; 14%, 12%, and 6% for CP-B7; and 23%, 32%, and 3% for ≥CP-B8. Median overall survival for CP-A patients was 13.3 mo (95% confidence interval [CI], 8.7-15.7 mo). CP-B7 and ≥CP-B8 patients exhibited median overall survival of 6.9 mo (95% CI, 5.3-10.1 mo) and 3.9 mo (95% CI, 2.9-5.0 mo), respectively. Significant overall survival prognosticators on univariate analysis were albumin, bilirubin, ascites, tumor size 5 cm or smaller, focality, distribution, infiltration, Eastern Cooperative Oncology Group status, AFP level, and PVT extent. Multivariate analysis showed the prognosticators of overall survival to be bilirubin, no ascites, tumor size 5 cm or smaller, solitary lesion, baseline AFP level lower than 100 ng/dL, and Eastern Cooperative Oncology Group status. Of 123 patients with a high AFP level (.100 ng/dL), 12 patients achieved restored normal AFP levels (,13 ng/dL) and exhibited median overall survival of 23.9 mo (95% CI, 20.1-124.1 mo). AFP responders at 1 mo had better overall survival than nonresponders, at 8.5 mo versus 4.8 mo (P 5 0.018); AFP responders at 3 mo had overall survival of 13.3 mo, versus 6.9 mo for nonresponders (P 5 0.021). Conclusion: 90 Y radioembolization can serve as a safe and effective treatment for advanced-stage HCC patients with tumor PVT. Overall survival outcomes are affected by baseline liver function, tumor size, and AFP level.

AB - We report survival outcomes for patients with advanced-stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with 90 Y radioembolization. Methods: With institutional review board approval, we searched our prospectively acquired database for 90 Y patients treated between 2003 and 2017. Inclusion criteria were patients who had HCC with tumor PVT. Patients with metastases were excluded. Laboratory data were collected at baseline and 1 mo after 90 Y radioembolization. Toxicity grades were reported according to the Common Terminology Criteria for Adverse Events, version 4.0, and long-term survival outcomes were reported and stratified by Child-Pugh class (CP). Overall survival was calculated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. A subanalysis for patients with a high level of α-fetoprotein (AFP) (.100 ng/dL) was conducted. Results: In total, 185 patients with HCC PVT underwent 90 Y radioembolization. Seventy-four (40%) were CP-A, 51 (28%) were CP-B7, and 60 (32%) were ≥CP-B8. New albumin, bilirubin, and alkaline phosphatase grade 3/4 toxicities were, respectively, 3%, 10%, and 0% for CP-A; 14%, 12%, and 6% for CP-B7; and 23%, 32%, and 3% for ≥CP-B8. Median overall survival for CP-A patients was 13.3 mo (95% confidence interval [CI], 8.7-15.7 mo). CP-B7 and ≥CP-B8 patients exhibited median overall survival of 6.9 mo (95% CI, 5.3-10.1 mo) and 3.9 mo (95% CI, 2.9-5.0 mo), respectively. Significant overall survival prognosticators on univariate analysis were albumin, bilirubin, ascites, tumor size 5 cm or smaller, focality, distribution, infiltration, Eastern Cooperative Oncology Group status, AFP level, and PVT extent. Multivariate analysis showed the prognosticators of overall survival to be bilirubin, no ascites, tumor size 5 cm or smaller, solitary lesion, baseline AFP level lower than 100 ng/dL, and Eastern Cooperative Oncology Group status. Of 123 patients with a high AFP level (.100 ng/dL), 12 patients achieved restored normal AFP levels (,13 ng/dL) and exhibited median overall survival of 23.9 mo (95% CI, 20.1-124.1 mo). AFP responders at 1 mo had better overall survival than nonresponders, at 8.5 mo versus 4.8 mo (P 5 0.018); AFP responders at 3 mo had overall survival of 13.3 mo, versus 6.9 mo for nonresponders (P 5 0.021). Conclusion: 90 Y radioembolization can serve as a safe and effective treatment for advanced-stage HCC patients with tumor PVT. Overall survival outcomes are affected by baseline liver function, tumor size, and AFP level.

KW - Hepatocellular carcinoma (HCC)

KW - Portal vein thrombosis (PVT)

KW - Y radioembolization

UR - http://www.scopus.com/inward/record.url?scp=85049392722&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049392722&partnerID=8YFLogxK

U2 - 10.2967/jnumed.117.199752

DO - 10.2967/jnumed.117.199752

M3 - Article

C2 - 29217739

AN - SCOPUS:85049392722

VL - 59

SP - 1042

EP - 1048

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 7

ER -