Long term outcome of patients with hepatocellular carcinoma treated with transarterial radioembolization

Introduction Yttrium-90 trans-arterial radioembolization (TARE) is a treatment indicated across many stages of hepatocellular carcinoma (HCC). Aims to assess radiological response, safety and overall survival (OS) of TARE in a cohort of consecutive patients treated from 2012 to 2021 in a single centre, identifying also predictors of OS. Materials and Methods incuded patients had: at least one measurable HCC, absence of extra-hepatic metastases, Child-Pugh (CPS) score A/B, ECOG performance status 0/1. Only the first TARE was considered in those patients who received more than one procedure. The radiological response by mRECIST criteria was evaluated 3/4 months after TARE. Uni- and multivariable analysis were used to explore the features at time of TARE and at time of the radiological evaluation possibly related with OS. Results Among 142 patients (median age 67 years, 85% males, 92% cirrhotics, BCLC A 29%, B 35%, C 36%, CPS A 85%, median AFP 27 ng/mL) the median OS was 16,7 months with a 28% of 3-yrs cumulative survival rate. According to radiological evaluation: 31%, 39%, 9% and 21% of patients had complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD), respectively. BCLC stage and AFP levels at time of TARE, delta AFP (difference between the value at TARE and at radiological evaluation), and radiological response were found to be statistically related to OS. AFP >21.4 ng/mL and BCLC C at TARE were significantly related with death [HR 1.48 (95%CI 1.00-2.18, p=0.048) and 1.71 (95%CI 1.05-2.79, p=0.031), respectively] although only radiological nonresponse had higher HR [3.34 (95%CI 2.03-5.79, p<0.0001)] for death at multivariate analysis. Adverse events, of which only one severe, occurred in 27% of patients. Conclusions TARE is an effective therapy for HCC patients across the different stages of the disease, and response to treatment remains the most important predictor of OS.