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Mourad SN, De la Garza-Ramos C, Toskich BB. Radiation Segmentectomy for the Treatment of Hepatocellular Carcinoma: A Practical Review of Evidence. Cancers (Basel) 2024; 16:669. [PMID: 38339418 PMCID: PMC10854641 DOI: 10.3390/cancers16030669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
Radiation segmentectomy is a versatile, safe, and effective ablative therapy for early-stage hepatocellular carcinoma. Advances in radiation segmentectomy patient selection, procedural technique, and dosimetry have positioned this modality as a curative-intent and guideline-supported treatment for patients with solitary HCC. This review describes key radiation segmentectomy concepts and summarizes the existing literary knowledgebase.
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Affiliation(s)
- Sophia N. Mourad
- College of Medicine, Florida State University, Orlando, FL 32301, USA
| | | | - Beau B. Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
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Karimi A, Yarmohammadi H, Erinjeri JP. Immune Effects of Intra-Arterial Liver-Directed Therapies. J Vasc Interv Radiol 2024; 35:178-184. [PMID: 38272638 DOI: 10.1016/j.jvir.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/08/2023] [Accepted: 10/21/2023] [Indexed: 01/27/2024] Open
Abstract
Image-guided intra-arterial locoregional therapies (LRTs) such as transarterial embolization, transarterial chemoembolization, and transarterial radioembolization exhibit effects on the immune system. Understanding the humoral (cytokine, chemokine, and growth factor) and cellular (T cell, neutrophil, dendritic cell, and macrophage) mechanisms underlying the immune effects of LRT is crucial to designing rational and effective combinations of immunotherapy and interventional radiology procedures. This article aims to review the immune effects of intra-arterial LRTs and provide insight into strategies to combine LRTs with systemic immunotherapy.
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Affiliation(s)
- Anita Karimi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph P Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Núñez KG, Sandow T, Gimenez J, Hibino M, Fort D, Cohen AJ, Thevenot PT. Lineage-specific regulation of PD-1 expression in early-stage hepatocellular carcinoma following 90yttrium transarterial radioembolization - Implications in treatment outcomes. Eur J Cancer 2024; 196:113442. [PMID: 37988841 DOI: 10.1016/j.ejca.2023.113442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related deaths in the world. Liver-directed therapies, including 90Yttrium (90Y) radioembolization, play an integral role in the management of HCC with excellent response rates. This has led to clinical trials of immunotherapy in combination with 90Y. Elevated PD-1 expression and lymphopenia were recently shown as risk factors for disease progression in early-stage HCC treated with liver-directed therapies. The aim of this study was to investigate PD-1 expression dynamics in bridge/downstage to transplant in HCC patients receiving first-cycle 90Y and evaluate the impact of these changes on response rates and time-to-progression (TTP). METHODS Patients with HCC receiving first-cycle 90Y as a bridge to liver transplantation (n = 99) were prospectively enrolled. Blood specimens were collected before 90Y and again during routine imagining follow-up to analyze PD-1 expression via flow cytometry. Complete and objective response rates (CR and ORR) were determined using mRECIST. RESULTS In 84/88 patients with available follow-up imaging, 83% had a localized ORR with 63% having localized CR. For overall response, 71% and 54% experienced ORR and CR, respectively. Post-90Y PD-1 upregulation in CD8 + associated with HCC progression and decreased TTP. Treatment with 90Y was associated with an anticipated significant post-treatment drop in lymphocytes (P < 0.001) that was independent of PD-1 expression for either CD4+ or CD8+ T cells (P = 0.751 and P = 0.375) and not associated with TTP risk. The change in lymphocytes was not correlated with PD-1 expression following treatment nor TTP. CONCLUSIONS Elevated PD-1 expression on peripheral T cells is associated with increased risk of HCC progression and shorter time to progression in bridging/downstaging to transplant HCC patients undergoing first-cycle 90Y. Treatment-induced lymphopenia was not associated with treatment response, or increased progression risk, suggesting this anticipated adverse event does not impact short-term HCC outcomes.
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Affiliation(s)
- Kelley G Núñez
- Institute of Translational Research, Ochsner Health System, New Orleans, LA, United States
| | - Tyler Sandow
- Interventional Radiology, Ochsner Health System, New Orleans, LA, United States
| | - Juan Gimenez
- Interventional Radiology, Ochsner Health System, New Orleans, LA, United States
| | - Mina Hibino
- Institute of Translational Research, Ochsner Health System, New Orleans, LA, United States
| | - Daniel Fort
- Center for Outcomes Research, Ochsner Health System, New Orleans, LA, United States
| | - Ari J Cohen
- Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, LA, United States; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Paul T Thevenot
- Institute of Translational Research, Ochsner Health System, New Orleans, LA, United States.
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Lee HN, Hyun D. Complications Related to Transarterial Treatment of Hepatocellular Carcinoma: A Comprehensive Review. Korean J Radiol 2023; 24:204-223. [PMID: 36788765 PMCID: PMC9971838 DOI: 10.3348/kjr.2022.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/27/2023] Open
Abstract
Currently, various types of transarterial treatments are performed for hepatocellular carcinoma from the early to advanced stages. Its indications and efficacy have been widely investigated. However, procedure-related complications have not been updated in the literature, although new types of transarterial treatments, such as drug-eluting bead transarterial chemoembolization and transarterial radioembolization, are common in daily practice. Herein, a comprehensive literature review was carried out, and complications were organized according to the organs affected and treatment modalities.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Prognostic Role of Molecular and Imaging Biomarkers for Predicting Advanced Hepatocellular Carcinoma Treatment Efficacy. Cancers (Basel) 2022; 14:cancers14194647. [PMID: 36230569 PMCID: PMC9564154 DOI: 10.3390/cancers14194647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Molecular biomarkers play a marginal role in clinical practice for hepatocellular carcinoma (HCC) diagnosis, surveillance and treatment monitoring. Radiological biomarker: alpha-fetoprotein is still a lone protagonist in this field. The potential role of molecular biomarkers in the assessment of prognosis and treatment results could reduce the health costs faced by standard radiology. The majority of efforts are oriented towards early HCC detection, but the field faces an important challenge to find adequate biomarkers for advanced HCC management. Abstract Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and the fourth cause of tumor-related death. Imaging biomarkers are based on computed tomography, magnetic resonance, and contrast-enhanced ultrasound, and are widely applied in HCC diagnosis and treatment monitoring. Unfortunately, in the field of molecular biomarkers, alpha-fetoprotein (AFP) is still the only recognized tool for HCC surveillance in both diagnostic and follow-up purposes. Other molecular biomarkers have little roles in clinical practice regarding HCC, mainly for the detection of early-stage HCC, monitoring the response to treatments and analyzing tumor prognosis. In the last decades no important improvements have been achieved in this field and imaging biomarkers maintain the primacy in HCC diagnosis and follow-up. Despite the still inconsistent role of molecular biomarkers in surveillance and early HCC detection, they could play an outstanding role in prognosis estimation and treatment monitoring with a potential reduction in health costs faced by standard radiology. An important challenge resides in identifying sufficiently sensitive and specific biomarkers for advanced HCC for prognostic evaluation and detection of tumor progression, overcoming imaging biomarker sensitivity. The aim of this review is to analyze the current molecular and imaging biomarkers in advanced HCC.
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Ni HH, Lu Z, Huang X, Ning SW, Liang XL, Zhang SY, Xiang BD. Combining Pre- and Postoperative Lymphocyte–C-Reactive Protein Ratios Can Better Predict Hepatocellular Carcinoma Prognosis After Partial Hepatectomy. J Inflamm Res 2022; 15:2229-2241. [PMID: 35411168 PMCID: PMC8994636 DOI: 10.2147/jir.s359498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background Various preoperative inflammatory indicators have been identified as potential predictors of poor prognosis in patients with hepatocellular carcinoma (HCC), but the role of postoperative inflammatory indicators remains unclear. This study aimed to explore the prognostic value of the postoperative lymphocyte–C-reactive protein ratio (PostLCR) on its own and combined with preoperative LCR (PreLCR). Methods A total of 290 patients with primary HCC were retrospectively enrolled in the study. Univariate analysis was used to identify factors significantly associated with poor disease-free survival (DFS) and overall survival (OS), then multivariate analysis was performed to identify independent prognostic indicators of poor survival. Prognostic models based on preoperative, postoperative, and both types of indicators were then constructed, and their predictive performance were evaluated using time-dependent receiver operating characteristic curves and the concordance index (C-index). Results PreLCR and PostLCR levels correlated with DFS and OS more strongly than other pre- and postoperative inflammatory indicators, respectively. Decreased PreLCR and PostLCR were independent prognostic factors for both DFS and OS, while HCC patients with decreased PreLCR and PostLCR had worse prognosis than patients with increased PreLCR and PostLCR. Patients into three groups based on their cut-off values of PreLCR and PostLCR, Kaplan–Meier survival analysis indicated that HCC patients with low PreLCR and PostLCR had the worst DFS and OS. The combined model showed better predictive performance at 1 and 3 years post-surgery than individual pre- and postoperative models, the American Joint Committee on Cancer/Tumor-Node-Metastasis (8th edition) staging system and the Barcelona Clinic Liver Cancer system. The combine model demonstrated a markedly superior C-index compared with the other models in DFS and OS. Conclusion Our study showed PreLCR and PostLCR are independent predictors of DFS and OS in HCC patients after partial hepatectomy. Models that include both PreLCR and PostLCR can predict prognosis better than well-established clinical staging systems.
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Affiliation(s)
- Hang Hang Ni
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People’s Republic of China
| | - Zhan Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People’s Republic of China
| | - Xi Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Shang Wu Ning
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Xiao Ling Liang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Shu Yi Zhang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Bang De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People’s Republic of China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, People’s Republic of China
- Correspondence: Bangde Xiang, Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People’s Republic of China, Tel +86-7715301253, Email
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Young S, Ragulojan R, Chen T, Owen J, D’souza D, Sanghvi T, Golzarian J, Flanagan S. Dynamic Lymphocyte Changes Following Transarterial Radioembolization: Association with Normal Liver Dose and Effect on Overall Survival. J Hepatocell Carcinoma 2022; 9:29-39. [PMID: 35155299 PMCID: PMC8824436 DOI: 10.2147/jhc.s350219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the dynamic changes of lymphocytes following transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) and their relationship to normal liver dose (NLD). Materials and Methods A total of 93 patients who underwent 102 treatments were retrospectively reviewed. Absolute lymphocyte counts pretreatment and at 1, 3, 6, and 12 months were evaluated. Kaplan–Meier, Spearman correlation, receiver operating characteristic (ROC) curve, and area under the curve (AUC) analyses were performed. Results The mean absolute lymphocyte count at baseline was 1.25 ± 0.79 103/µL which was significantly greater than 1 (0.71 ± 0.47 103/µL, p<0.0001), 3 (0.79 ± 0.77 103/µL, p=0.0003), and 6 (0.81 ± 0.44 103/µL, p=0.0001) months, but not significantly different than 12 (0.92 ± 0.8 103/µL, p=0.12) months post treatment. There was a modest negative correlation between NLD and lymphocyte count at 1 month (rho= −0.216, p=0.03), which strengthened at 3 months post treatment (rho= −0.342, p=0.008). AUC of ROC analysis between absolute lymphocyte count ≤1 103/µL or >1 103/µL at 1, 3, 6, and 12 months post treatment was 0.625, 0.676, 0.560, and 0.794, respectively. Univariate analysis of overall survival when separating patients by a lymphocyte count of ≤1 103/µL and >1 103/µL demonstrated a significant difference at 1 (HR: 0.56, 95% CI: 0.33–0.95, p=0.03), 3 (HR: 0.41, 95% CI: 0.18–0.94, p=0.035) and 6 (HR: 0.36, 95% CI: 0.17–0.77, p=0.008) months post treatment, but not pretreatment or at 12 months. Conclusion NLD may correlate with lymphocyte depression at 1 and 3 months and lymphopenia may portend a worse overall survival in the post treatment setting.
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Affiliation(s)
- Shamar Young
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
- Correspondence: Shamar Young, Tel +1 612-624-6189, Email
| | - Ranjan Ragulojan
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Ting Chen
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Joshua Owen
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Donna D’souza
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Tina Sanghvi
- Minneapolis VA Medical Center, Department of Radiology, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
| | - Siobhan Flanagan
- University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA
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Carr BI, Bag HG, Ince V, Akbulut S, Ersan V, Usta S, Isik B, Ogut Z, Tuncer A, Yilmaz S. A Combination of Blood Lymphocytes and AST Levels Distinguishes Patients with Small Hepatocellular Carcinomas from Non-cancer Patients. J Gastrointest Cancer 2021; 52:1211-1216. [PMID: 34762264 PMCID: PMC8799503 DOI: 10.1007/s12029-021-00740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE HCC patients typically present at an advanced tumor stage, in which surgical therapies cannot be used. Screening ultrasound exams can increase the numbers of patients diagnosed with small tumors, but are often not used in patients at risk for HCC. We evaluated clinically available and cheap potential blood tests as biomarkers for screening patients at risk for HCC. METHODS A comparison was made of commonly used blood count and liver function parameters in a group of patients (n = 101) with small HCCs (≤ 3 cm) or without HCC (n = 275), who presented for liver transplantation in our institute. RESULTS Significant differences were found for blood lymphocytes and AST levels. This 2-parameter combination was found to be significantly different between patients with small HCCs versus no HCC. Using the combination of lymphocytes and AST levels to dichotomize the HCC patients, only blood levels of alpha-fetoprotein among the tumor characteristics were found to be significantly different among the 2 HCC groups, as well as levels of blood total bilirubin, ALKP, and PLR ratio. The results were confirmed using a separate smaller cohort of non-transplanted small size HCC patients. CONCLUSION The combination of elevated blood levels of lymphocyte counts and AST levels holds promise for screening of patients with chronic liver disease who are at risk for HCC.
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Affiliation(s)
- Brian I Carr
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey.
| | - Harika Gozukara Bag
- Department of Biostatistics, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Volkan Ince
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Burak Isik
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Zeki Ogut
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Adem Tuncer
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
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De la Garza-Ramos C, Toskich BB. Radioembolization for the Treatment of Hepatocellular Carcinoma: The Road to Personalized Dosimetry and Ablative Practice. Semin Intervent Radiol 2021; 38:466-471. [PMID: 34629715 DOI: 10.1055/s-0041-1735571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radioembolization dosimetry for the treatment of hepatocellular carcinoma has evolved alongside our understanding of best practice for this therapy. At the core of advances in dosimetry are personalized and ablative applications of radioembolization, which have generated paradigm shifts in both safety and efficacy. This review provides a summary of fundamental radioembolization dosimetry concepts and narrates how our approach to treating patients has shifted from conventional to tailored and definitive therapy.
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Affiliation(s)
| | - Beau B Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
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De la Garza-Ramos C, Overfield CJ, Montazeri SA, Liou H, Paz-Fumagalli R, Frey GT, McKinney JM, Ritchie CA, Devcic Z, Lewis AR, Harnois DM, Patel T, Toskich BB. Biochemical Safety of Ablative Yttrium-90 Radioembolization for Hepatocellular Carcinoma as a Function of Percent Liver Treated. J Hepatocell Carcinoma 2021; 8:861-870. [PMID: 34368021 PMCID: PMC8335548 DOI: 10.2147/jhc.s319215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/06/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Transarterial radioembolization can serve as an ablative therapy for early-stage hepatocellular carcinoma (HCC). Given the volumetric variability of liver segments, this study aimed to characterize the safety of ablative radioembolization by determining percent liver treated (%LT) thresholds associated with biochemical toxicity. Patients and Methods Patients with HCC receiving a single ablative radioembolization treatment using glass microspheres from 2017 through 2020 were reviewed. %LT was calculated as treatment angiosome volume divided by whole liver volume. Biochemical toxicities were defined as increases in Albumin-Bilirubin (ALBI) grade or Child-Pugh (CP) class compared to baseline and albumin or bilirubin adverse events (AEs) per the Common Terminology Criteria for Adverse Events. Receiver operating characteristic curves and multivariate logistic regression analyses were performed to assess the impact of %LT on toxicities. Results Of 141 patients analyzed, 53% (n=75) were ALBI 1, 45% (n=64) ALBI 2, 79% (n=111) CP-A, and 21% (n=30) CP-B. A %LT ≥14.5% was associated with grade/class increases in ALBI 2 (p≤0.01) and CP-B patients (p=0.026). In multivariate analysis, a %LT ≥14.5% was an independent predictor of increases in the ALBI 2 and CP-B groups (p<0.01). No significant %LT threshold was found for ALBI 1 and CP-A patients. No grade 3/4 albumin or bilirubin AEs were reported, while grade 2 AEs were related to an initial whole liver volume <1.3 L (p≤0.01). Conclusion Patients with ALBI 2 and CP-B liver function are less likely to have an increase in their respective grade/class when treating <14.5% of the liver using glass microspheres. ALBI 1 and CP-A patients showed no definitive %LT threshold for biochemical toxicity within the range of this study.
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Affiliation(s)
| | - Cameron J Overfield
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - S Ali Montazeri
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Harris Liou
- Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Gregory T Frey
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - J Mark McKinney
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Charles A Ritchie
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Zlatko Devcic
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew R Lewis
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Denise M Harnois
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Tushar Patel
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Beau B Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
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