Yttrium-90 Radioembolization for BCLC Stage C Hepatocellular Carcinoma Comparing Child-Pugh A Versus B7 Patients: Are the Outcomes Equivalent?

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.