Tumor Burden Thresholds Associated with Successful Downstaging After Yttrium-90 Radioembolization in Hepatocellular Carcinoma Beyond UCSF Criteria.

Authors

Chun-Hua Chiu, Chun-Yen Yu, Hsin-You Ou, Leung-Chit Tsang, Po-Hsun Huang, Ching-Chun Weng, Yi Lu, Chao-Long Chen, Yu-Fan Cheng

Published in

Journal of hepatocellular carcinoma. Volume 13. Pages 613375. Epub Jul 10, 2026.

Abstract

Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages, limiting access to curative therapies. Yttrium-90 (Y-90) trans-arterial radioembolization (TARE) has been used for tumor downstaging to enable surgical resection or liver transplantation; however, the factors associated with successful downstaging and potential selection thresholds remain unclear.
We retrospectively analyzed 65 patients with unresectable HCC exceeding the University of California, San Francisco (UCSF) criteria who underwent Y-90 TARE between 2020 and 2024. Tumor burden parameters, dosimetric features, treatment response, overall survival (OS), and progression-free survival (PFS) were evaluated. Receiver operating characteristic (ROC) analysis was performed to identify exploratory thresholds associated with successful downstaging, and survival outcomes were assessed using Kaplan-Meier methods.
Down-staging to within UCSF criteria was achieved in 58.5% of patients. Successfully down-staged patients had significantly longer OS than non-downstaged patients (median OS, not reached vs. 18.8 months; p = 0.034). ROC analysis identified exploratory tumor burden thresholds associated with downstaging failure, including largest tumor diameter ≥7.8 cm, tumor volume ≥265 cm³, and a composite tumor number-diameter score >11. The presence of multiple adverse tumor burden factors was associated with a high likelihood of downstaging failure. When adequate tumor radiation delivery was achieved, a tumor-to-normal uptake ratio (T/N) >4 predicted successful downstaging in tumors <7.8 cm, whereas its prognostic value diminished in larger lesions.
Y-90 TARE enables effective downstaging in a substantial proportion of patients with advanced HCC and may facilitate subsequent curative surgery or living donor liver transplantation. Tumor burden metrics and size-dependent T/N ratios were associated with successful downstaging and may assist patient selection for Y-90 TARE. These findings should be considered exploratory and warrant validation in larger prospective studies.

PMID:
42453922
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.