Prospective longitudinal quality of life and survival outcomes in patients with advanced infiltrative hepatocellular carcinoma and portal vein thrombosis treated with Yttrium-90 radioembolization

Minzhi Xing, Nima Kokabi, Juan C Camacho, Hyun S Kim, Minzhi Xing, Nima Kokabi, Juan C Camacho, Hyun S Kim

Abstract

Background: To determine the effect of Yttrium-90 (Y90) radioembolization on health-related quality of life (HRQOL) and its effect on overall survival advanced, unresectable infiltrative hepatocellular carcinoma (HCC) patients with concurrent portal vein thrombosis (PVT).

Methods: Consecutive patients with unresectable infiltrative HCC and PVT were recruited. The Short-Form 36 (SF-36) questionnaire was used to assess HRQOL for consecutive patients treated with glass-based Y90 based on a prospective phase II trial. MR imaging was used to determine tumor progression every 3 months post-treatment. Overall survival (OS) from treatment and time to progression (TTP) was analyzed using Kaplan-Meier estimation and log-rank test.

Results: Thirty patients were treated and followed for 17.4 months; physical and mental component summary scores (PCS & MCS) remained unchanged at one, three, and six months. While no difference was observed in baseline SF-36 scores for patients with prolonged TTP (≥4 months) and OS (≥ 6 months), corresponding 1-month PCS were significantly higher than those with TTP < 4 months and OS < 6 months. At 1 month, patients with normalized Physical Function (PF), Role Physical (RP) and PCS within 2 standard deviations (SD) of US normalized baseline scores had a significantly prolonged median OS (15.7 vs. 3.7 months; p < 0.001) and TTP (12.4 vs. 1.8 mo; p < 0.001) compared those with physical component scores greater than 2SD below normalized US population values.

Conclusion: Y90 radioembolization for HCC demonstrated long-term preservation of HRQOL. Lower baseline HRQOL scores were predictive of poorer OS. Early (1 month post-treatment) significant decreases in PCS were independent predictors of poorer OS and TTP.

Trial registration: ClinicalTrials.gov identifier NCT01556282 , registered March 16, 2012.

Keywords: Hepatocellular carcinoma; Locoregional therapies; Quality of life; Yttrium-90 radioembolization.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval to conduct this study was provided by the Emory University Institutional Review Board. Informed consent to participate in this study was obtained from each participant prior to study enrollment. The study was registered at Consent for publication

This manuscript contains only aggregate results and does not present any individual person’s data. This manuscript does not contain details, images, or videos relating to any individual person and therefore does not require written informed consent from each individual for publication.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison of mean SF-36 HRQOL Normalized Baseline Scores for patients with HCC prior to Y90 therapy (bars) versus mean SF-36 HRQOL scores of an age-adjusted healthy US population (lines). a Raw SF-36 scores compared to US population means; (b) Normalized SF-36 scores. Significantly lower HRQOL scores were observed in patients at baseline compared to the mean US healthy population (p < 0.001). PF: Physical Functioning; RP: Role-Physical; BP: Bodily Pain; GH: General Health; VT: Vitality; SF: Social Functioning; RE: Role Emotional; MH: Mental Health; MCS: Mental Component Summary Score; PCS: Physical Component Summary Score
Fig. 2
Fig. 2
Longitudinal analysis of HRQOL after Y90 radioembolization demonstrating lack of significant change in health-related quality of life pre- and post-Y90 therapy, and over the course of 6-month follow-up. PF: Physical Functioning; RP: Role-Physical; BP: Bodily Pain; GH: General Health; VT: Vitality; SF: Social Functioning; RE: Role Emotional; MH: Mental Health
Fig. 3
Fig. 3
Kaplan Meier analysis of HRQOL for patients who had PCS within 2 standard deviations (SD) vs. those with PCS >2SD below US normalized baseline scores. At 1 month post-Y90, patients with PCS demonstrated: (a) Significantly prolonged median OS (15.7 months vs. 3.7 months; p < 0.001); and (b) Significantly prolonged time to progression (12.4 months vs. 1.8 months; p < 0.001) compared those with physical component scores >2SD below normalized US population values

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