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

Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ronald A. Mora, Laura Kulik, Michael Abecassis, Ahsun Riaz, Riad Salem, Robert J. Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)260-269
Number of pages10
JournalCardiovascular and Interventional Radiology
Volume41
Issue number2
DOIs
StatePublished - Feb 1 2018

Keywords

  • Barcelona Clinic Liver Cancer (BCLC) staging
  • Eastern Cooperative Oncology Group (ECOG) performance status
  • Hepatocellular Carcinoma (HCC)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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