Scientific Abstracts: Liver
Objective: Surgical Resection is considered curative for those with solitary hepatocellular carcinoma (HCC) and preserved liver function, but it is limited to those with adequate future liver remnant (FLR). Radioembolization (Y90) is used to improve margins and increase FLR, converting patients to surgical candidates. We aimed to study outcome differences between HCC patients who underwent resection vs. those requiring neoadjuvant Y90 prior to resection.
Methods: With IRB approval, we studied patients with HCC resected between 2011-2014. Patients were categorized as resectable per multi-discipline tumor board vs. those deemed initially unresectable but converted to surgical resection with neoadjuvant Y90 (radiation lobectomy). Recurrence and survival outcomes were compared between these cohorts. Time to recurrence (TTR), recurrence free survival (RFS), and overall survival (OS) and were estimated using Kaplan-Meier method.
Results: 17 treatment naïve patients underwent surgical resection vs. 13 HCC patients that required neoadjuvant Y90. Mean age was 60 for resection cohort vs. 63 for neoadjuvant Y90 cohort (p=0.5). Median tumor size was 4.1 cm in resection cohort vs. 5.6 cm for neoadjuvant Y90 cohort (p=0.28). All patients had Child-Pugh A liver function. There was 1 (6%) 90-day mortality rate in resection cohort and 0% in neoadjuvant Y90 cohort. Resection cohort explants showed 100% viable tumors without necrosis. At explant, 5 (38%) had complete tumor necrosis and 8 (62%) had partial (>50%) necrosis in the neoadjuvant Y90 cohort. Time to recurrence analysis was similar between cohorts; median was not reached at 80 months follow-up. RFS was similar between cohorts, where 5-year RFS was 51% for resection cohort vs. 56% for neoadjuvant Y90 cohort (p=0.67). Overall survival outcomes were also similar between cohorts, with 5-year OS of 74% for resection patients vs. 83% for neoadjuvant Y90 patients (P=0.59).
Conclusions: Neoadjuvant Y90 can convert patients with HCC initially declared unresectable and denied surgery into resection candidates, while providing the same recurrence and survival advantages as those deemed optimal resection candidates at presentation.