Risk Stratification and Contemporary Predictors of Survival in Hepatocellular Carcinoma Treated With Transarterial Radioembolization

Authors

• Deepak Sherpally, New York Medical College
• Parthib Das, The Ohio State University Comprehensive Cancer Center
• Fode Tounkara, The Ohio State University
• Khalid Mumtaz, The Ohio State University Wexner Medical Center
• Mina S. Makary, The Ohio State University Wexner Medical Center
• Samuel Paul, The Ohio State University
• Eric Min, The Ohio State University
• Austin J. Sim, The Ohio State University Comprehensive Cancer Center
• Anne Noonan, The Ohio State University Comprehensive Cancer Center
• Pannaga Malalur, The Ohio State University Comprehensive Cancer Center
• John Hays, The Ohio State University Comprehensive Cancer Center
• Ning Jin, The Ohio State University Comprehensive Cancer Center
• Arjun Mittra, The Ohio State University Comprehensive Cancer Center
• Eric Miller, The Ohio State University Comprehensive Cancer Center
• Dayssy Diaz Pardo, The Ohio State University Comprehensive Cancer Center
• Kenneth Pitter, The Ohio State University Comprehensive Cancer Center
• Ashish Manne, The Ohio State University Comprehensive Cancer Center

DOI

10.14740/gr2049

Journal Title

Gastroenterology Research

First Page

207

Last Page

223

Document Type

Article

Publication Date

10-1-2025

Department

Medicine

Keywords

Hepatocellular carcinoma, Liver function, Risk stratification, TARE, Transarterial radioembolization, Y90

Disciplines

Medicine and Health Sciences

Abstract

Background: Identifying risk factors for poor outcomes in patients with hepatocellular carcinoma (HCC) treated with transarterial radioemboli-zation (TARE) can aid in developing personalized management strate-gies, such as the early use of immune checkpoint inhibitors (ICIs). Results: We included 141 patients (median age of 65 years; 80% Caucasian; 80% male). Better PFS was associated with higher albumin (alb) (hazard ratio (HR) = 0.58, P = 0.005) and lower total bilirubin (T bili) levels (HR = 0.70, P = 0.034). Better OS was associated with a history of ablation (HR = 0.35, P < 0.001) and higher pre-TARE alb (HR = 0.63, P = 0.01); OS was worse in those with hepatic encephalopathy (HR = 2.01, P = 0.006). There was a notable trend toward worse OS in patients with ascites (HR = 1.71, P = 0.06) and metabolic-dysfunction-associated fatty liver disease (MAFLD)-associated HCC (HR = 1.86, P = 0.08). The receipt of ICI therapy was associated with a significantly better OS (P = 0.016), with a median OS of 1,102 days (95% confidence interval (CI): 884-1,509) compared to 614 days (95% CI: 493-829). Conclusion: We present pretreatment risk factors (low alb, high T bili, MAFLD, hepatic encephalopathy, and ascites) that can predict poor outcomes in HCC patients treated with TARE. Preemptively treating such high-risk patients with ICI could improve their outcomes.

Recommended Citation

Sherpally, D., Das, P., Tounkara, F., Mumtaz, K., Makary, M., Paul, S., Min, E., Sim, A., Noonan, A., Malalur, P., Hays, J., Jin, N., Mittra, A., Miller, E., Pardo, D., Pitter, K., & Manne, A. (2025). Risk Stratification and Contemporary Predictors of Survival in Hepatocellular Carcinoma Treated With Transarterial Radioembolization. Gastroenterology Research, 18 (5), 207-223. https://doi.org/10.14740/gr2049