BACKGROUND & AIMS Yttrium-90 transarterial radioembolization (TARE) has shown promising efficacy in the treatment of patients with hepatocellular carcinoma (HCC), associated with portal vein tumor thrombus (PVTT). The aim of this study is to identify prognostic factors for survival in patients with HCC and PVTT undergoing TARE, and build a prognostic classification for these patients. METHODS This is a single center retrospective study conducted over six years (2010-2015), on consecutive patients undergoing TARE. Patients were included if they met the following criteria: presence of at least one measurable HCC, presence of PVTT not occluding the main portal trunk, absence of extrahepatic metastases, Child-Pugh score within B7, Eastern Cooperative Oncology Group performance status 0-1. Uni- and multivariable analysis was used to explore the variables that showed an independent relationship with survival. A prognostic score was then derived, and three prognostic categories were identified. RESULTS A total of 120 patients were included in the study. Median overall survival (OS) was 14.1 months (95% CI 10.7-17.5) and median progression-free survival (PFS) was 6.5 months (95% CI 3.8-9.2). The only variables independently correlated with OS were bilirubin, extension of PVTT and tumor burden. Three prognostic categories were identified: favourable prognosis (0 points), intermediate prognosis (2-3 points) and dismal prognosis (>3 points). Median OS in the three categories was 32.2 months, 14.9 months and 7.8 months respectively (p <0.0001). PFS (p = 0.045) and the risk of liver decompensation (p <0.0001) also significantly differed along the same prognostic categories. CONCLUSIONS Radioembolization with Yttrium-90 is an effective therapy for patients with HCC and PVTT. The proposed prognostic stratification may help to better identify good candidates for the treatment, and those for whom TARE may be futile. LAY SUMMARY Yttrium-90 transarterial radioembolization (TARE) is a microembolic procedure that minimizes alterations to hepatic arterial flow, and thus can be safely performed in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). In this study, we retrospectively evaluated the independent predictors of long-term outcomes in patients with HCC and PVTT treated with TARE. Bilirubin level, extension of PVTT and tumor burden were independently related to post-treatment survival: the combination of these factors allowed us to build a prognostic stratification that may help to better identify good candidates for the treatment, and those for whom TARE may be futile.

中文翻译：

---

开发预后评分以预测对伴有门静脉侵犯的肝细胞癌患者对钇 90 放射栓塞的反应

背景和目的 Yttrium-90 经动脉放射栓塞 (TARE) 在治疗肝细胞癌 (HCC) 与门静脉癌栓 (PVTT) 相关的患者中显示出有前景的疗效。本研究的目的是确定接受 TARE 的 HCC 和 PVTT 患者生存的预后因素，并为这些患者建立预后分类。方法 这是一项为期六年（2010-2015 年）的单中心回顾性研究，对连续接受 TARE 的患者进行。如果患者符合以下标准，则包括在内：存在至少一个可测量的 HCC、存在 PVTT 未阻塞门脉主干、不存在肝外转移、Child-Pugh 评分在 B7 以内、东部肿瘤协作组表现状态 0-1。使用单变量和多变量分析来探索与生存率具有独立关系的变量。然后得出预后评分，并确定了三个预后类别。结果 本研究共包括 120 名患者。中位总生存期 (OS) 为 14.1 个月（95% CI 10.7-17.5），中位无进展生存期（PFS）为 6.5 个月（95% CI 3.8-9.2）。与 OS 独立相关的唯一变量是胆红素、PVTT 的扩展和肿瘤负荷。确定了三个预后类别：预后良好（0分）、中等预后（2-3分）和预后差（>3分）。三类的中位 OS 分别为 32.2 个月、14.9 个月和 7.8 个月（p <0.0001）。PFS (p = 0.045) 和肝脏失代偿风险 (p < 0. 0001）在相同的预后类别中也有显着差异。结论 钇 90 放射栓塞是 HCC 和 PVTT 患者的有效治疗方法。建议的预后分层可能有助于更好地确定治疗的良好候选者，以及那些 TARE 可能无效的人。概述 Yttrium-90 经动脉放射栓塞 (TARE) 是一种微栓塞手术，可最大限度地减少肝动脉血流的改变，因此可以安全地用于肝细胞癌 (HCC) 和门静脉癌栓 (PVTT) 患者。在本研究中，我们回顾性评估了 TARE 治疗的 HCC 和 PVTT 患者长期预后的独立预测因素。胆红素水平、PVTT 的延长和肿瘤负荷与治疗后的存活率独立相关：