PMID- 34532122 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220426 IS - 2078-6891 (Print) IS - 2219-679X (Electronic) IS - 2078-6891 (Linking) VI - 12 IP - 4 DP - 2021 Aug TI - Prognostic factors of unresectable hepatocellular carcinoma treated with yttrium-90 radioembolization: results from a large cohort over 13 years at a single center. PG - 1718-1731 LID - 10.21037/jgo-20-435 [doi] AB - BACKGROUND: A previous study of patients with unresectable hepatocellular carcinoma (HCC) was extended to further examine factors associated with overall survival (OS) after selective internal radiation therapy with yttrium-90 resin microspheres (Y90 SIRT). METHODS: Data from patients of any age diagnosed with unresectable HCC and treated with Y90 SIRT at our institution from 2004 through 2017 were retrospectively analyzed. Among other criteria, patients had to have Eastern Cooperative Oncology Group performance status 0 to 2, not have received Y90 SIRT previously, and not have extrahepatic disease. Primary outcome was OS; secondary outcomes included tumor response and adverse events (AEs). Kaplan-Meier survival analyses and multivariable Cox proportional hazards models were used to evaluate prognostic factors for OS. RESULTS: Of the 226 patients, 59% were White, 77% were male, and the mean age at first SIRT procedure was 65.1+/-9.4 years. More than half had received previous treatment for HCC. The most common etiology was hepatitis C (n=138/224 available, 62%), followed by alcohol use (n=45, 20%), and nonalcoholic steatohepatitis (n=27, 12%). The mean model for end-stage liver disease score at baseline was 8.8+/-2.2. Patients were followed-up for a median of 12.2 months (95% CI, 0.0-62.6). Median OS was 16.6 months (95% CI, 13.1 to not reached). Bilobar disease, higher albumin-bilirubin score at baseline, prior treatment with sorafenib, alcohol use etiology, and higher administered dose were associated with shorter survival, whereas subsequent liver transplant [in 26 patients (11.5%)] was associated with longer survival. Of the 186 patients with AEs data, 75 (40.3%) patients reported an event and, of these, 13 (17.3%) patients had grade 4 bilirubin values. CONCLUSIONS: In a large, diverse population treated at a single center over 13 years, Y90 SIRT produced a median OS of 16.6 months in patients with unresectable HCC and enabled subsequent transplantation in a subset of patients. Factors affecting the length of survival should be considered when making treatment decisions for unresectable HCC. CI - 2021 Journal of Gastrointestinal Oncology. All rights reserved. FAU - Shah, Rucha M AU - Shah RM AD - Gastroenterology and Hepatology, Methodist Dallas Medical Center, Dallas, TX, USA. FAU - Sheikh, Sarah AU - Sheikh S AD - The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA. FAU - Shah, Jimmy AU - Shah J AD - Methodist Digestive Institute, Methodist Dallas Medical Center, Dallas, TX, USA. FAU - Vivian, Elaina AU - Vivian E AD - The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA. FAU - Mejia, Alejandro AU - Mejia A AD - The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA. FAU - Shahin, Islam AU - Shahin I AD - Interventional Radiology, Methodist Dallas Medical Center, Dallas, TX, USA. FAU - Mantry, Parvez S AU - Mantry PS AD - The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA. LA - eng PT - Journal Article PL - China TA - J Gastrointest Oncol JT - Journal of gastrointestinal oncology JID - 101557751 PMC - PMC8421891 OTO - NOTNLM OT - Radioembolization OT - liver cancer OT - liver-directed therapy OT - locoregional treatment OT - selective internal radiation therapy (SIRT) COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jgo-20-435). PSM has received research funding, consulting fees, or other funds from Intercept, Abbvie, Gilead, Merck, Salix, Eisai, BMS, Sirtex, Genfit, Allergan, Celgene, Pfizer, Hepquant, Mallinckrodt, Galmed, Viking, Cymabay, Blade, Roche, LAM, and Novartis. IS has received funds from and has served as a speaker for Sirtex. The authors have no other conflicts of interest to declare. EDAT- 2021/09/18 06:00 MHDA- 2021/09/18 06:01 PMCR- 2021/08/01 CRDT- 2021/09/17 07:16 PHST- 2020/10/09 00:00 [received] PHST- 2021/06/08 00:00 [accepted] PHST- 2021/09/17 07:16 [entrez] PHST- 2021/09/18 06:00 [pubmed] PHST- 2021/09/18 06:01 [medline] PHST- 2021/08/01 00:00 [pmc-release] AID - jgo-12-04-1718 [pii] AID - 10.21037/jgo-20-435 [doi] PST - ppublish SO - J Gastrointest Oncol. 2021 Aug;12(4):1718-1731. doi: 10.21037/jgo-20-435.