title: A new model to estimate prognosis in patients with hepatocellular carcinoma after Yttrium-90 radioembolization.
abstract: OBJECTIVE
  The current prognostic model to estimate the survival in hepatocellular carcinoma (HCC) patients treated with transarterial hepatic selective internal radiotherapy (SIRT) is not fully characterized. The aim of this study was to establish a new scoring model including assessment of both tumor responses and therapy-induced systemic changes in HCC patients to predict survival at an early time point post-SIRT.
  
  
  METHODS
  Between 2008 and 2012, 149 HCC patients treated with SIRT were included into this study. CT images and biomarkers in blood tested at one month post-SIRT were analyzed and correlated with clinical outcome. Tumor responses were assessed by RECIST 1.1, mRECIST, and Choi criteria. Kaplan-Meier methods were used to estimate survival curves. Cox regression was used in uni- and multivariable survival analyses and in the establishment of a prognostic model.
  
  
  RESULTS
  A multivariate proportional hazards model was created based on the tumor response, the number of tumor nodules, the score of the model for end stage liver disease (MELD), and the serum C-reactive protein levels which were independent predictors of survival in HCC patients at one month post-SIRT. This prognostic model accurately differentiated the outcome of patients with different risk scores in this cohort (P<0.001). The model also had the ability to assign a predicted survival probability for individual patients.
  
  
  CONCLUSIONS
  A new model to predict survival of HCC patients mainly based on tumor responses and therapy-induced systemic changes provides reliable prognosis and accurately discriminates the survival at an early time point after SIRT in these patients.
authors.affiliation: Department of Hepatology and Gastroenterology, University Hospital of Essen, Essen, Germany ; Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Weng
authors.affiliation: Department of Hepatology and Gastroenterology, University Hospital of Essen, Essen, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Ertle
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Shaoping
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauenstein
authors.affiliation: Institute for Nuclear Medicine, University Hospital of Essen, Essen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Institute for Nuclear Medicine, University Hospital of Essen, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.affiliation: Department of Hepatology and Gastroenterology, University Hospital of Essen, Essen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.affiliation: Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Hepatology and Gastroenterology, University Hospital of Essen, Essen, Germany.
authors.forename: Joerg F
authors.initials: JF
authors.lastname: Schlaak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D058625:End Stage Liver Disease / Q000532:radiotherapy / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D055815:Young Adult; D015019:Yttrium / Q000627:therapeutic use*
chemical_list: D015019:Yttrium