Improved survival following transarterial radioembolization of infiltrative-appearance hepatocellular carcinoma

Michael J. Nisiewicz, Harit Kapoor, Kathryn J. Fowler, Alessandro Furlan, Adam J. Dugan, Joseph W. Owen

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Purpose: Infiltrative-appearance hepatocellular carcinoma presents a challenge to clinicians as diagnostic criteria continue to evolve and evidence-based treatment guidelines have yet to be established. While transarterial radioembolization has shown efficacy in hepatocellular carcinoma, many studies exclude infiltrative-appearance HCC in their analysis. The purpose of this study was to describe imaging features of infiltrative-appearance hepatocellular carcinoma and evaluate effects of radioembolization on survival. Methods: In a retrospective review, infiltrative HCC patients treated from 2008 to 2017 were identified. Patients were divided into two groups: TARE versus systemic therapy/palliative care. Demographics, dates of diagnosis/expiry, albumin, international normalized ratio (INR), sodium, alpha-fetoprotein (AFP), creatinine, Child-Pugh class, model for end-stage liver disease (MELD) score, bilirubin, radiation dose and volume were collected. Patients with bilirubin > 3 were excluded. Mann–Whitney U test and Fisher’s exact test assessed differences between groups. Kaplan–Meier survival and Cox proportional hazard analyses were performed. Results: Fifty-three patients were identified, 15 underwent TARE while 38 served as control. Mean age was 60, 43 patients were male. The mean overall survival was 16.2 months for the TARE group and 5.3 months for the control group (Log-rank p < 0.0001). Cox proportional regression analysis revealed significant associations between survival and albumin (HR 0.210, 0.052–0.839, p = 0.027), Child-Pugh class B (HR 0.196, 0.055–0.696, p = 0.012), sorafenib (HR 0.106, 0.031–0.360, p < 0.001), and number of affected liver lobes (HR 1.864, 1.387–2.506, p < 0.001). Conclusions: Transarterial radioembolization for infiltrative HCC improves life expectancy compared to treatment with comfort measures or systemic therapy.

Original languageEnglish
Pages (from-to)1958-1966
Number of pages9
JournalAbdominal Radiology
Volume46
Issue number5
DOIs
StatePublished - May 2021

Bibliographical note

Publisher Copyright:
© 2021, Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Cancer
  • Hepatocellular carcinoma
  • Infiltrative
  • Radioembolization
  • Survival

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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