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Background <p>To evaluate treatment response and identify factors associated with outcomes in previously treated hepatocellular carcinoma (HCC) patients receiving Y-90 radioembolization combined with targeted therapy and immunotherapy (Y-90 + TT + IT).</p> Methods <p>This retrospective study included 30 previously treated HCC patients (11 with prior surgery, 19 without) who received Y-90 + TT + IT. At a median follow-up of 9.7 months (95% CI, 8.5–13.9), 23 PFS events and 9 overall survival (OS) events occurred. Patient‑level response was assessed in 24 patients (all with PFS events or &gt; 6‑month follow‑up without progression). Univariable Cox regression was used for PFS and OS; owing to few OS events (<i>n</i> = 9), OS analyses were exploratory. For PFS, an exploratory multivariable model (backward stepwise) was also constructed.</p> Results <p>Objective response rate was 37.5% (9/24) and disease control rate 75.0% (18/24); infiltrative imaging appearance was the only feature associated with non‑response (<i>p</i> = 0.042). Prior surgery was associated with worse PFS in both patient-level (HR 3.78, <i>p</i> = 0.004) and lesion-level (HR 3.32, <i>p</i> = 0.024) analyses; however, the lesion-level association was not confirmed in a sensitivity analysis restricted to one index lesion per patient (<i>p</i> = 0.128) and should be interpreted cautiously as it may reflect within‑patient clustering. Prior surgery remained significant in multivariable analysis (<i>p</i> = 0.004). In univariable analysis for OS, total bilirubin (<i>p</i> = 0.019), lesion number (<i>p</i> = 0.022), gamma-glutamyl transferase (GGT; <i>p</i> = 0.041), and tumor-to-normal liver uptake ratio (TNR; <i>p</i> = 0.008) were associated with OS.</p> Conclusions <p>In this exploratory cohort of previously treated HCC patients receiving Y-90 + TT + IT, prior surgery was associated with worse patient‑level PFS. Infiltrative imaging appearance was associated with non‑response. In univariable analysis, GGT, TNR, total bilirubin, and lesion number showed exploratory associations with OS. These findings generate hypotheses and require validation in larger prospective studies.</p>

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Prognostic factors and treatment response in previously treated hepatocellular carcinoma patients receiving Y-90 radioembolization combined with targeted-immunotherapy: an exploratory analysis

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Jianwei Chen,
  • Xiaolong Wang,
  • Xiaoqi Li,
  • Qihong Chen,
  • Yuemin Zhu,
  • Dechun Zheng,
  • Liting Wen,
  • Juyi Wu,
  • Yubin Hu,
  • Shiguang Chen,
  • Mingzhi Hao,
  • Wenchang Yu,
  • Zhuting Fang

摘要

Background

To evaluate treatment response and identify factors associated with outcomes in previously treated hepatocellular carcinoma (HCC) patients receiving Y-90 radioembolization combined with targeted therapy and immunotherapy (Y-90 + TT + IT).

Methods

This retrospective study included 30 previously treated HCC patients (11 with prior surgery, 19 without) who received Y-90 + TT + IT. At a median follow-up of 9.7 months (95% CI, 8.5–13.9), 23 PFS events and 9 overall survival (OS) events occurred. Patient‑level response was assessed in 24 patients (all with PFS events or > 6‑month follow‑up without progression). Univariable Cox regression was used for PFS and OS; owing to few OS events (n = 9), OS analyses were exploratory. For PFS, an exploratory multivariable model (backward stepwise) was also constructed.

Results

Objective response rate was 37.5% (9/24) and disease control rate 75.0% (18/24); infiltrative imaging appearance was the only feature associated with non‑response (p = 0.042). Prior surgery was associated with worse PFS in both patient-level (HR 3.78, p = 0.004) and lesion-level (HR 3.32, p = 0.024) analyses; however, the lesion-level association was not confirmed in a sensitivity analysis restricted to one index lesion per patient (p = 0.128) and should be interpreted cautiously as it may reflect within‑patient clustering. Prior surgery remained significant in multivariable analysis (p = 0.004). In univariable analysis for OS, total bilirubin (p = 0.019), lesion number (p = 0.022), gamma-glutamyl transferase (GGT; p = 0.041), and tumor-to-normal liver uptake ratio (TNR; p = 0.008) were associated with OS.

Conclusions

In this exploratory cohort of previously treated HCC patients receiving Y-90 + TT + IT, prior surgery was associated with worse patient‑level PFS. Infiltrative imaging appearance was associated with non‑response. In univariable analysis, GGT, TNR, total bilirubin, and lesion number showed exploratory associations with OS. These findings generate hypotheses and require validation in larger prospective studies.