Survival Benefit of Aggressive Treatment Approaches Incorporating Yttrium-90 Radioembolization for Late-Stage Hepatocellular Carcinoma

Objectives: To evaluate treatment allocation and outcomes for Barcelona Clinic Liver Cancer (BCLC) stage C and D hepatocellular carcinoma (HCC) following our institution's multidisciplinary approach utilizing yttrium-90 radioembolization (Y90). Methods: All new HCC diagnoses discussed at our multidisciplinary tumor board, 2010–2013, were included. Charts were reviewed for demographics, tumor characteristics, laboratory values, treatment, and outcomes on an intention-to-treat basis (resection, transplant, ablation, Y90, transarterial chemoembolization, sorafenib, palliative therapy). Patients received a BCLC stage at initial treatment. Survival analyses were performed from first treatment date until death, loss to follow-up, or end of capture period (April 2, 2019). Results: Over 4 years, 321 treatment-naïve patients with HCC were enrolled, of which 33% were BCLC C and 15% were BCLC D. Between these two stages, the median age was 61 years with predominance of hepatitis C-associated disease (39%, 60). Median follow-up and median overall survival (mOS) were 13 and 15 months (95% confidence interval [CI] 18–88), respectively. Table 1 describes treatment groups and BCLC-discordance by stage. Y90 comprised 65% and 50% of BCLC-discordant treatments in BCLC C and D patients, respectively. BCLC-discordant patients had longer mOS in BCLC C (hazard ratio [HR] 0.27, 95% CI: 0.12–0.60, 25 vs. 4 months, P = 0.001) and D (HR 0.16, 95% CI: 0.06–0.39, 47 vs. 2 months, P < 0.001) groups. mOS of BCLC C and D patients bridged to curative therapy was 64 (43–81) and 72 (58–85) months, respectively. Actual mOS was longer in Y90 (43 vs. 32 months, P < 0.001) and transplant (61 vs. 16 months, P < 0.001) groups compared to expected mOS by BCLC stage. Conclusion: This analysis of a large cohort of untreated HCC demonstrates significant survival benefit in BCLC C and D patients when incorporating Y90 in the treatment algorithm, supporting more aggressive locoregional therapies that limit disease progression.

Publication History

Article published online:
26 April 2021