Association of bilirubin and overall survival in veterans who receive radioembolization for hepatocellular carcinoma treatment

Sunday, March 5, 2023

3:36 PM – 3:45 PM

Location: Phoenix Convention Center, 227ABC

Presenting Author(s)

Lynne Martin, MD

Resident
Stanford

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

MC

Marcello Chang, MCS

Medical Student
Stanford
SM

Sarah Miller, MD

Resident
Stanford
Aakash Gupta, M.D.

Interventional Radiology Resident, PGY-2
Stanford University
SK

Sirish Kishore, MD

Interventional Radiologist
Palo Alto Veterans Affairs Healthcare System/Stanford University School of Medicine
Nishita Kothary, MD

Professor of Radiology
Stanford University School of Medicine
RS

Rajesh P. Shah

Disclosure(s):

Lynne Martin, MD: No financial relationships to disclose

Sirish Kishore, MD: Boston Scientific: Research Grant Recipient (Terminated, November 30, 2021); Canon Medical Systems: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); INARI MEDICAL, INC.: Consultant (Ongoing), Speaking and Teaching (Ongoing); InterVene: Consultant (Ongoing); Trisalus Life Sciences: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Varian Interventional Solutions: Research Grant Recipient (Ongoing)

Nishita Kothary, MD: Boston Scientific Corp: Stock (Ongoing); Neptune medical: Management Position (Ongoing), Ownership Interest (Ongoing), Salaried Employee (Ongoing); Quantum surgical: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); Varian Interventional Solutions: Consultant (Ongoing)

Purpose: To evaluate the overall survival (OS) of patients who underwent transarterial radioembolization (TARE) for treatment of hepatocellular carcinoma (HCC) with a total bilirubin (TB) of > 1 mg/dL compared a TB ≤ 1 mg/dL.

Materials and Methods: All patients with a diagnosis of HCC in the Veterans Affairs (VA) Informatics and Computing Infrastructure since 2000 was queried. Patients who underwent treatment of HCC from 2008-2020 with TARE were selected. Patients were divided into two groups based on the TB value immediately prior to TARE. Group A consisted of those with TB ≤ 1 mg/dL while Group B had a TB > 1 mg/dL. Groups were 2:1 propensity matched on patient age, race, ethnicity, year of diagnosis, hepatitis B, hepatitis C, Charlson Comorbidity Index, Barcelona Clinic Liver Cancer staging, and Eastern Cooperative Oncology Group performance status. A Kaplan-Meier survival analysis was performed evaluating OS and a hazard ratio was calculated. A log-rank test was used to calculate a p-value with p < 0.05 considered statistically significant. A logistic regression (LR) model was used to predict the probability of survival at 1 and 2 months for Group B. Data was randomly split into 70% trained (n = 197) and 30% test (n = 70) cohort. Input variables for the LR model were albumin, TB, platelets, white blood cell count, hemoglobin, alkaline phosphatase, aspartate transaminase, model for end-stage liver disease, age, international normalized ratio, creatinine, alcoholism, history of smoking, and history of cirrhosis. A receiver operating characteristic (ROC) curve was generated and the area under the curve (AUROC) was calculated.

Results: There were 62,658 patients with HCC with 1,070 patients receiving TARE. After matching, a total of 220 patients were in Group A and 110 patients in Group B. Group B had significantly shorter OS than Group A (12.2 months vs 21.9 months). For one and two month mortality outcomes in Group B, the AUROC for the LR model was 0.74 and 0.70 respectively in the training set, and 0.74 and 0.70 respectively in the test set.

Conclusion: A TB >2 mg/dL has widely been accepted as the value in which patients are no longer considered for TARE. These results suggest that providers should consider a more nuanced approach to their selection of patients with a TB >1 mg/dL for TARE and additional lab values and parameters should be taken into account.