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.

Keywords: hepatocellular carcinoma, radioembolization, Y-90, adverse events


中文翻译：

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肝细胞癌消融性钇90放射栓塞的生化安全性与肝治疗百分比的关系

目的：经动脉放射栓塞可作为早期肝细胞癌（HCC）的消融治疗。鉴于肝段的体积变异性，本研究旨在通过确定与生化毒性相关的肝脏治疗百分比 (%LT) 阈值来表征消融放射栓塞的安全性。
患者和方法：回顾了从 2017 年到 2020 年接受使用玻璃微球单次消融放射栓塞治疗的 HCC 患者。%LT 计算为治疗血管体积除以全肝体积。根据不良事件通用术语标准，生化毒性定义为与基线和白蛋白或胆红素不良事件 (AE) 相比，白蛋白-胆红素 (ALBI) 等级或 Child-Pugh (CP) 等级增加。进行受试者操作特征曲线和多变量逻辑回归分析以评估 %LT 对毒性的影响。
结果：在分析的 141 名患者中，53% (n=75) 为 ALBI 1、45% (n=64) ALBI 2、79% (n=111) CP-A 和 21% (n=30) CP-B . %LT ≥ 14.5% 与 ALBI 2 的年级/班级增加相关（p≤ 0.01) 和 CP-B 患者 ( p =0.026)。在多变量分析中，%LT ≥ 14.5% 是 ALBI 2 和 CP-B 组增加的独立预测因子 ( p < 0.01)。对于 ALBI 1 和 CP-A 患者，未发现显着的 %LT 阈值。未报告 3/4 级白蛋白或胆红素 AE，而 2 级 AE 与初始全肝体积 < 1.3 L ( p ≤ 0.01) 有关。
结论：当使用玻璃微球治疗 <14.5% 的肝脏时，ALBI 2 和 CP-B 肝功能的患者在各自的等级/类别中不太可能增加。ALBI 1 和 CP-A 患者在本研究范围内没有显示生化毒性的明确 %LT 阈值。

关键词：肝细胞癌，放射栓塞，Y-90，不良事件