Choi Jin Woo, Suh Minseok, Choi Yunhee, Lee Myungsu, Paeng Jin Chul, Kim Hyo-Cheol
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Eur Radiol. 2025 Jul 26. doi: 10.1007/s00330-025-11882-w.
To evaluate the outcomes of yttrium-90 radioembolization (glass microspheres) in patients with unilobar hepatocellular carcinoma (HCC) and portal vein invasion (PVI) who have preserved liver function.
This study included 48 patients with unilobar HCC and PVI, all with Child-Pugh A, treated with radioembolization at a single institution between January 2016 and December 2023. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and localized mRECIST. Overall survival (OS) and prognostic factors were evaluated using time-to-event analyses. The mean tumor absorbed dose (TAD) threshold for achieving complete response (CR) by localized mRECIST was determined using receiver operating characteristic analysis, while the threshold associated with significantly longer OS was identified using the minimum p-value approach.
Objective response rates were 83% (40/48) by mRECIST and 88% (42/48) by localized mRECIST. The median OS was 47.2 months (95% CI, 19.1-52.1 months). The TAD was the only significant predictor of OS (p = 0.032, hazard ratio = 0.862 per 100 Gy, 95% CI = 0.753-0.988). A mean TAD > 574 Gy provided 50% sensitivity and 86% specificity for predicting CR by localized mRECIST, while a threshold of 586 Gy was proposed to significantly extend OS (median OS, 49.5 months for > 586 Gy and 21.9 months for ≤ 586 Gy; p = 0.021).
Radioembolization is effective for HCC with localized PVI in patients with preserved liver function, and a mean TAD > 600 Gy is proposed to achieve improved oncologic outcomes.
Question What is the optimal radioembolization approach and its outcome for hepatocellular carcinoma with localized portal vein invasion (Vp1-3) in patients with preserved liver function? Findings A tumor absorbed dose exceeding 600 Gy via a tandem approach achieved complete response rates above 80% and median overall survival longer than 49.5 months. Clinical relevance Ablative radioembolization, delivering a tumor absorbed dose exceeding 600 Gy via a tandem approach, should be considered for hepatocellular carcinoma with localized portal vein tumor thrombosis (Vp1-3) in patients with preserved liver function and no extrahepatic spread.
评估钇-90放射性栓塞（玻璃微球）治疗单叶肝细胞癌（HCC）合并门静脉侵犯（PVI）且肝功能良好患者的疗效。
本研究纳入48例单叶HCC合并PVI患者，均为Child-Pugh A级，于2016年1月至2023年12月在单一机构接受放射性栓塞治疗。采用改良实体瘤疗效评价标准（mRECIST）和局部mRECIST评估肿瘤反应。采用事件发生时间分析评估总生存期（OS）和预后因素。使用受试者工作特征分析确定通过局部mRECIST达到完全缓解（CR）的平均肿瘤吸收剂量（TAD）阈值，同时使用最小p值法确定与显著更长OS相关的阈值。
根据mRECIST评估的客观缓解率为83%（40/48），根据局部mRECIST评估为88%（42/48）。中位OS为47.2个月（95%CI，19.1 - 52.1个月）。TAD是OS的唯一显著预测因素（p = 0.032，风险比 = 每100 Gy为0.862，95%CI = 0.753 - 0.988）。平均TAD > 574 Gy预测局部mRECIST达到CR的敏感度为50%，特异度为86%，而建议阈值为586 Gy以显著延长OS（> 586 Gy的中位OS为49.5个月，≤ 586 Gy为21.9个月；p = 0.021）。
放射性栓塞对肝功能良好的局部PVI HCC有效，建议平均TAD > 600 Gy以改善肿瘤学结局。
问题对于肝功能良好的局部门静脉侵犯（Vp1 - 3）肝细胞癌，最佳放射性栓塞方法及其疗效如何？发现通过串联方法肿瘤吸收剂量超过600 Gy可实现完全缓解率高于80%，中位总生存期超过49.5个月。临床意义对于肝功能良好且无肝外转移的局部门静脉肿瘤血栓形成（Vp1 - 3）肝细胞癌，应考虑采用串联方法进行消融性放射性栓塞，使肿瘤吸收剂量超过600 Gy。
