Analysis of prognostic factors after yttrium-90 radioembolization of advanced hepatocellular carcinoma.

ABSTRACT

PURPOSE: To analyze which patient-, tumor-, and treatment-related factors may influence outcome after (90)Y radioembolization ((90)Y-RE) for hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Seventy-two consecutive patients with advanced HCC treated with (90)Y-RE were studied to detect which factors may have influenced response to treatment and survival. RESULTS: Median overall survival was 13 months (95% confidence interval, 9.6-16.3 months). In univariate analysis, survival was significantly better in patients with one to five lesions (19 vs. 8 months, p = 0.001) and in patients with alpha-fetoprotein <52 UI/mL (24 vs. 11 months, p = 0.002). The variation in target tumor size and the appearance of new lesions were analyzed among 50 patients with measurable tumors. A decrease in target tumor size was observed in most patients, and the intensity of such decrease was not associated with any of the factors under study. Patients who developed new lesions in the treated liver (and also in the nontargeted liver) at month 3 more frequently had more than five nodules, bilobar disease, and alpha-fetoprotein >52 UI/mL, and their survival in the multivariate analysis was significantly worse (hazard ratio, 4.7; 95% confidence interval, 13-1.73) (p = 0.002). CONCLUSIONS: Yttrium-90 radioembolization results in control of target lesions in the majority of patients with HCC but does not prevent the development of new lesions. Survival of patients treated with (90)Y-RE seems to depend largely on factors related to the aggressiveness of the disease (number of nodules, levels of alpha-fetoprotein, and presence of microscopic disease).