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 M Kulik, Michael Messod Abecassis, Ahsun Riaz, Riad Salem, Robert J Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

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

Fingerprint

Liver Neoplasms
Survival Analysis
Blood Vessels
Hepatocellular Carcinoma
Neoplasm Metastasis
Portal Vein
Survival
Thrombosis
Multivariate Analysis
Yttrium
Proportional Hazards Models
Databases

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

Cite this

@article{418956d43be64005b549b578cc63bfa5,
title = "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.",
keywords = "Barcelona Clinic Liver Cancer (BCLC) staging, Eastern Cooperative Oncology Group (ECOG) performance status, Hepatocellular Carcinoma (HCC)",
author = "Rehan Ali and Ahmed Gabr and Nadine Abouchaleh and {Al Asadi}, Ali and Mora, {Ronald A.} and Kulik, {Laura M} and Abecassis, {Michael Messod} and Ahsun Riaz and Riad Salem and Lewandowski, {Robert J}",
year = "2018",
month = "2",
day = "1",
doi = "10.1007/s00270-017-1791-1",
language = "English (US)",
volume = "41",
pages = "260--269",
journal = "CardioVascular and Interventional Radiology",
issn = "7415-5101",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Survival Analysis of Advanced HCC Treated with Radioembolization

T2 - Comparing Impact of Clinical Performance Status Versus Vascular Invasion/Metastases

AU - Ali, Rehan

AU - Gabr, Ahmed

AU - Abouchaleh, Nadine

AU - Al Asadi, Ali

AU - Mora, Ronald A.

AU - Kulik, Laura M

AU - Abecassis, Michael Messod

AU - Riaz, Ahsun

AU - Salem, Riad

AU - Lewandowski, Robert J

PY - 2018/2/1

Y1 - 2018/2/1

N2 - 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.

AB - 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.

KW - Barcelona Clinic Liver Cancer (BCLC) staging

KW - Eastern Cooperative Oncology Group (ECOG) performance status

KW - Hepatocellular Carcinoma (HCC)

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U2 - 10.1007/s00270-017-1791-1

DO - 10.1007/s00270-017-1791-1

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JO - CardioVascular and Interventional Radiology

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SN - 7415-5101

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