Key points are not available for this paper at this time.
It is unknown whether baseline ascites must be considered as a limiting factor for Y90 radioembolization of the primary liver tumors. We aimed to study the epidemiology of patients with primary liver tumors who underwent radioembolization and had ascites at baseline. All 294 Y90 deliveries (242 patients) performed between Jan 2013-Jul 2020 in a single center were retrospectively reviewed. Patients with tumor progression, main portal vein thrombosis, or prior lobar chemoembolization were excluded. Cross-sectional imaging and number of paracenteses before and within 6 months after Y90 were reviewed. Ascites was graded grade 1, if perihepatic; grade 2, between grade 1 and 2; grade 3 pelvic and paracolic ascites. Size of treated lesion(s), treated area (lobar if delivery was via left or right hepatic arteries; segmental if via segmental branch; divisional if none of these), total activity delivered and baseline and follow-up labs were reviewed. Development of ascites and liver failure was evaluated after each delivery. Logistic regression analysis was performed for risk factors of liver failure including baseline ascites as a risk factor. Survival curves plotted for overall patients' survival. Mean (SD) age was 66 (11). 209 were male (71%). 272 (93%), 11 (3.5%), and 11 (3.5%) had hepatocellular carcinoma, intrahepatic cholangiocarcinoma and biphenotypic tumor, respectively. In 62 (of 294, 20%) encounters there was ascites at baseline. New onset or worsened ascites occurred in 125 (of 294, 43%) 96 (33%) new onset, 29 (10%) worsened. Ascites was moderate-severe in 65 (52%). Patients with ascites after Y90, have significantly more bilirubin elevation (p=0.01). Multiple logistic regression analysis showed male gender (OR=2.1, p=0.01), baseline Albumin levels (OR=0.4, p=0.003) and ALBI score (OR=2.89, p< 0.001) were significantly associated with new or worsened ascites. Baseline ascites, extent of Y90 infusion, total dose administered, and Child-Pugh and MELD scores were not associated with ascites or worsening liver function. Cox proportional hazards model showed worse survival in patients who developed ascites (HR=2.1, p< 0.001). Baseline ascites was not independently associated, but albumin and ALBI score were significantly associated with ascites and liver failure after radioembolization. Development of new or worsened ascites after radioembolization was associated with increased mortality.
Jabboure et al. (Wed,) studied this question.