Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR, 97239, USA.
Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China.
Cardiovasc Intervent Radiol. 2020 May;43(5):721-731. doi: 10.1007/s00270-020-02434-4. Epub 2020 Mar 5.
To evaluate yttrium-90 (Y90) radioembolization outcomes across Child-Pugh scores in patients with advanced hepatocellular carcinoma (HCC).
From April 2005 to December 2018, 106 consecutive patients with BCLC Stage C HCC who underwent Y90 radioembolization were retrospectively analyzed. Exclusion criteria included additional malignancy (n = 7), death unrelated to liver disease (n = 2), metastases (n = 2), or lack of follow-up data (n = 4). Ninety-one patients were analyzed. Overall survival (OS) was calculated using the Kaplan-Meier method and compared between groups with the log-rank test. Cox regression modeling was used to evaluate the prognostic factors for survival.
Mean age was 63 years and 85.7% were male. HCV infection was the most common etiology of liver disease (58.2%). Sixty-four (70.3%) patients were Child-Pugh A, 19 (20.9%) patients were B7, and eight (8.8%) patients were B8-9. Median OS after radioembolization was 20.2 [95% confidence interval (CI) 13.0-27.4], 6.0 (95% CI 4.4-7.6), and 5.5 (95% CI 2.5-8.5) months for Child-Pugh A, B7, and B8/9 groups, respectively (P < 0.001 for B7 vs. A; P = 0.537 for B7 vs. B8/9). The multivariable Cox regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score (P < 0.001), Child-Pugh class (P = 0.005), tumor morphology pattern (P = 0.012), and Y90 delivery location (P = 0.020) were significant independent predictors of overall survival.
Outcomes from Y90 for BCLC C HCC for Child-Pugh B7 patients were equivalent to B8/9 patients and significantly worse compared to Child-Pugh A patients. Although further research is warranted, these results suggest continued cautious patient selection for radioembolization in advanced HCC.
评估钇-90（Y90）放射性栓塞在不同 Child-Pugh 评分的晚期肝细胞癌（HCC）患者中的治疗效果。
2005 年 4 月至 2018 年 12 月，回顾性分析了 106 例接受 Y90 放射性栓塞的 BCLC 分期 C HCC 患者。排除标准包括：其他恶性肿瘤（n=7）、与肝病无关的死亡（n=2）、转移（n=2）或缺乏随访数据（n=4）。91 例患者纳入分析。采用 Kaplan-Meier 法计算总生存期（OS），并用对数秩检验比较组间差异。采用 Cox 回归模型评估生存的预后因素。
平均年龄为 63 岁，85.7%为男性。HCV 感染是最常见的肝病病因（58.2%）。64 例（70.3%）患者为 Child-Pugh A，19 例（20.9%）患者为 B7，8 例（8.8%）患者为 B8-9。Y90 放射性栓塞后中位 OS 分别为 20.2 [95%置信区间（CI）13.0-27.4]、6.0（95% CI 4.4-7.6）和 5.5（95% CI 2.5-8.5）个月，Child-Pugh A、B7 和 B8/9 组之间差异具有统计学意义（B7 与 A 比较，P<0.001；B7 与 B8/9 比较，P=0.537）。多变量 Cox 回归分析显示，东部肿瘤协作组（ECOG）评分（P<0.001）、Child-Pugh 分级（P=0.005）、肿瘤形态学类型（P=0.012）和 Y90 放射性栓塞位置（P=0.020）是总体生存的独立显著预测因素。
对于 Child-Pugh B7 患者，钇-90 治疗 BCLC C HCC 的疗效与 B8/9 患者相当，而与 Child-Pugh A 患者相比显著更差。尽管需要进一步研究，但这些结果提示在晚期 HCC 中对放射性栓塞治疗应继续谨慎选择患者。
