title: Analysis of prognostic factors after yttrium-90 radioembolization of advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  To analyze which patient-, tumor-, and treatment-related factors may influence outcome after (90)Y radioembolization ((90)Y-RE) for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Seventy-two consecutive patients with advanced HCC treated with (90)Y-RE were studied to detect which factors may have influenced response to treatment and survival.
  
  
  RESULTS
  Median overall survival was 13 months (95% confidence interval, 9.6-16.3 months). In univariate analysis, survival was significantly better in patients with one to five lesions (19 vs. 8 months, p = 0.001) and in patients with alpha-fetoprotein <52 UI/mL (24 vs. 11 months, p = 0.002). The variation in target tumor size and the appearance of new lesions were analyzed among 50 patients with measurable tumors. A decrease in target tumor size was observed in most patients, and the intensity of such decrease was not associated with any of the factors under study. Patients who developed new lesions in the treated liver (and also in the nontargeted liver) at month 3 more frequently had more than five nodules, bilobar disease, and alpha-fetoprotein >52 UI/mL, and their survival in the multivariate analysis was significantly worse (hazard ratio, 4.7; 95% confidence interval, 13-1.73) (p = 0.002).
  
  
  CONCLUSIONS
  Yttrium-90 radioembolization results in control of target lesions in the majority of patients with HCC but does not prevent the development of new lesions. Survival of patients treated with (90)Y-RE seems to depend largely on factors related to the aggressiveness of the disease (number of nodules, levels of alpha-fetoprotein, and presence of microscopic disease).
authors.affiliation: Liver Unit, Department of Internal Medicine, Clinica Universitaria de Navarrra, Pamplona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.forename: Antonio
authors.initials: A
authors.lastname: Martinez-Cuesta
authors.forename: Macarena
authors.initials: M
authors.lastname: Rodríguez
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Bilbao
authors.forename: Javier
authors.initials: J
authors.lastname: Arbizu
authors.forename: Alberto
authors.initials: A
authors.lastname: Benito
authors.forename: Félix
authors.initials: F
authors.lastname: Alegre
authors.forename: Delia
authors.initials: D
authors.lastname: D'Avola
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Herrero
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
authors.forename: Jesús
authors.initials: J
authors.lastname: Prieto
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D013668:Technetium Tc 99m Aggregated Albumin; D047368:Tumor Burden; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes; D000509:alpha-Fetoproteins