Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma
Purpose. This study aims to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) in patients undergoing Yttrium-90 radioembolization (Y90-RE) for hepatocellular carcinoma (HCC). Methods. Retrospectively, patients with Y90-...
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Series: | Canadian Journal of Gastroenterology and Hepatology |
Online Access: | http://dx.doi.org/10.1155/2021/9926704 |
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doaj-b9566ec88cb1448eab6c3cb1d1d0fdd32021-08-02T00:00:50ZengHindawi LimitedCanadian Journal of Gastroenterology and Hepatology2291-27972021-01-01202110.1155/2021/9926704Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular CarcinomaAlexander Villalobos0William Wagstaff1Mian Guo2James Zhang3Zachary Bercu4Morgan J. Whitmore5Mircea M Cristescu6Bill S. Majdalany7Joel Wedd8Mehmet Akce9Joseph Magliocca10Nima Kokabi11Department of Radiology and Imaging SciencesDepartment of Radiology and Imaging SciencesDepartment of Biostatistics and BioinformaticsDepartment of Radiology and Imaging SciencesDepartment of Radiology and Imaging SciencesDepartment of Radiology and Imaging SciencesDepartment of Radiology and Imaging SciencesDepartment of Radiology and Imaging SciencesDivision of Digestive DiseasesDepartment of Hematology and Medical OncologyDivision of TransplantationDepartment of Radiology and Imaging SciencesPurpose. This study aims to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) in patients undergoing Yttrium-90 radioembolization (Y90-RE) for hepatocellular carcinoma (HCC). Methods. Retrospectively, patients with Y90-RE naïve HCC who were candidates or potential candidates for LT and underwent Y90-RE were included. Patients were then divided into favorable (maintained or achieved Milan criteria (MC) eligibility) or unfavorable (lost eligibility or unchanged MC ineligibility) cohorts based on changes to their MC eligibility after Y90-RE. Penalized logistic regression analysis was performed to identify the significant baseline prognosticators. Results. Between 2013 and 2018, 135 patients underwent Y90-RE treatment. Among the 59 (42%) patients within MC, LT eligibility was maintained in 49 (83%) and lost in 10 (17%) patients. Within the 76 (56%) patients outside MC, eligibility was achieved in 32 (42%) and unchanged in 44 (58%). Among the 81 (60%) patients with a favorable response, 16 (20%) went on to receive LT. Analysis of the baseline characteristics revealed that lower Albumin-Bilirubin score, lower Child–Pugh class, lower Barcelona Clinic Liver Cancer stage, HCC diagnosis using dynamic contrast-enhanced imaging on CT or MRI, normal/higher albumin levels, decreased severity of tumor burden, left lobe HCC disease, and absence of HBV-associated cirrhosis, baseline abdominal pain, or fatigue were all associated with a higher likelihood of bridging or downstaging to LT eligibility (p’s < 0.05). Conclusion. Certain baseline clinical and tumor characteristics are associated with the successful bridging or downstaging of potential LT candidates with HCC undergoing Y90-RE.http://dx.doi.org/10.1155/2021/9926704 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alexander Villalobos William Wagstaff Mian Guo James Zhang Zachary Bercu Morgan J. Whitmore Mircea M Cristescu Bill S. Majdalany Joel Wedd Mehmet Akce Joseph Magliocca Nima Kokabi |
spellingShingle |
Alexander Villalobos William Wagstaff Mian Guo James Zhang Zachary Bercu Morgan J. Whitmore Mircea M Cristescu Bill S. Majdalany Joel Wedd Mehmet Akce Joseph Magliocca Nima Kokabi Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma Canadian Journal of Gastroenterology and Hepatology |
author_facet |
Alexander Villalobos William Wagstaff Mian Guo James Zhang Zachary Bercu Morgan J. Whitmore Mircea M Cristescu Bill S. Majdalany Joel Wedd Mehmet Akce Joseph Magliocca Nima Kokabi |
author_sort |
Alexander Villalobos |
title |
Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma |
title_short |
Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma |
title_full |
Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma |
title_fullStr |
Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma |
title_full_unstemmed |
Predictors of Successful Yttrium-90 Radioembolization Bridging or Downstaging in Patients with Hepatocellular Carcinoma |
title_sort |
predictors of successful yttrium-90 radioembolization bridging or downstaging in patients with hepatocellular carcinoma |
publisher |
Hindawi Limited |
series |
Canadian Journal of Gastroenterology and Hepatology |
issn |
2291-2797 |
publishDate |
2021-01-01 |
description |
Purpose. This study aims to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) in patients undergoing Yttrium-90 radioembolization (Y90-RE) for hepatocellular carcinoma (HCC). Methods. Retrospectively, patients with Y90-RE naïve HCC who were candidates or potential candidates for LT and underwent Y90-RE were included. Patients were then divided into favorable (maintained or achieved Milan criteria (MC) eligibility) or unfavorable (lost eligibility or unchanged MC ineligibility) cohorts based on changes to their MC eligibility after Y90-RE. Penalized logistic regression analysis was performed to identify the significant baseline prognosticators. Results. Between 2013 and 2018, 135 patients underwent Y90-RE treatment. Among the 59 (42%) patients within MC, LT eligibility was maintained in 49 (83%) and lost in 10 (17%) patients. Within the 76 (56%) patients outside MC, eligibility was achieved in 32 (42%) and unchanged in 44 (58%). Among the 81 (60%) patients with a favorable response, 16 (20%) went on to receive LT. Analysis of the baseline characteristics revealed that lower Albumin-Bilirubin score, lower Child–Pugh class, lower Barcelona Clinic Liver Cancer stage, HCC diagnosis using dynamic contrast-enhanced imaging on CT or MRI, normal/higher albumin levels, decreased severity of tumor burden, left lobe HCC disease, and absence of HBV-associated cirrhosis, baseline abdominal pain, or fatigue were all associated with a higher likelihood of bridging or downstaging to LT eligibility (p’s < 0.05). Conclusion. Certain baseline clinical and tumor characteristics are associated with the successful bridging or downstaging of potential LT candidates with HCC undergoing Y90-RE. |
url |
http://dx.doi.org/10.1155/2021/9926704 |
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