Comparative outcomes of trans-arterial radioembolization in patients with non-alcoholic steatohepatitis/non-alcoholic fatty liver disease-induced HCC: a retrospective analysis

• Published in: Abdominal imaging Vol. 49; no. 8; pp. 2714 - 2725
• Main Authors: Brunson, Christopher, Struycken, Lucas, Schaub, David, Ref, Jacob, Goldberg, Daniel, Hannallah, Jack, Woodhead, Gregory, Young, Shamar
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2024; Springer Nature B.V
• Subjects: Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Effectiveness; Fatty liver; Gastroenterology; Hepatocellular carcinoma; Hepatology; Imaging; Interventional Radiology; Liver; Liver cancer; Liver diseases; Medicine; Medicine & Public Health; Population studies; Radiology; Solid tumors; Statistical models; Subgroups; Survival; Tumorigenesis; Hepatocellular carcinoma; Radiation dosimetry; Fatty liver disease; Yttrium-90
• ISSN: 2366-0058; 2366-004X; 2366-0058
• DOI: 10.1007/s00261-024-04295-8

Purpose Tumorigenesis in NAFLD/NASH-induced HCC is unique and may affect the effectiveness of trans-arterial radioembolization in this population. The purpose of this study was to retrospectively compare the effectiveness of trans-arterial radioembolization for the treatment of hepatocellular carcinoma (HCC) between patients with non-alcoholic steatohepatitis (NASH)/non-alcoholic fatty liver disease (NAFLD) and non-NASH/NAFLD liver disease. Materials and methods Consecutive patients with HCC who underwent TARE at a single academic institution were retrospectively reviewed. Outcome measures including overall survival (OS), local progression-free survival (PFS), and hepatic PFS as assessed by modified response evaluation criteria in solid tumors (mRECIST) were recorded. Kaplan–Meier and Cox proportional hazard models were utilized to compare progression-free survival and overall survival. Results 138 separate HCCs in patients treated with TARE between July 2013 and July 2022 were retrospectively identified. Etiologies of HCC included NASH/NAFLD (30/122, 22%), HCV (52/122, 43%), alcoholic liver disease (25/122, 21%), and combined ALD/HCV (14/122, 11%). NASH/NAFLD patients demonstrated a significantly higher incidence of type 2 diabetes mellitus ( p  < 0.0001). There was no significant difference in overall survival ( p  = 0.928), local progression-free survival ( p  = 0.339), or hepatic progression-free survival between the cohorts ( p  = 0.946) by log-rank analysis. When NASH/NAFLD patients were compared to all combined non-NASH/NAFLD patients, there was no significant difference in OS (HR 1.1, 95% C.I. 0.32–3.79, p  = 0.886), local PFS (HR 1.2, 95% C.I. 0.58–2.44, p  = 0.639), or hepatic PFS (HR 1.3, 95% C.I. 0.52–3.16, p  = 0.595) by log-rank analysis. Conclusion TARE appears to be an equally effective treatment for NASH/NAFLD-induced HCC when compared to other causes of HCC. Further studies in a larger cohort with additional subgroup analyses are warranted. Graphical abstract