Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma

Objective: The aim of this study was to evaluate the efficacy of Yttrium-90 Transarterial Radioembolization (TARE) to convert to resection initially unresectable, single, large (≥5 cm) hepatocellular carcinoma (HCC). Summary Background Data: TARE can downsize cholangiocarcinoma to resection but its role in hepatocellular carcinoma (HCC) resectability remains debatable. Methods: All consecutive patients with a single large HCC treated between 2015 and 2020 in a single tertiary centre were reviewed. When indicated, patients were either readily resected (Upfront-surgery) or underwent TARE. TARE patients were converted to resection (TARE-surgery) or not (TARE-only). To further assess the effect of TARE on the long and short-term outcomes, a propensity score matching (PSM) analysis was performed. Results: Among 216 patients, 144 (66.7%) underwent upfront surgery. Among 72 TARE patients, 20 (27.7%) were converted to resection. TARE-surgery patients received a higher mean Yttrium-90 dose that the 52 remaining TARE-only patients (211.89 Gy ± 107.98 vs. 128.7 Gy ± 36.52, P <0.001). Post-operative outcomes between Upfront-surgery and TARE-surgery patients were similar. In the unmatched population, overall survival (OS) at 1, 3, and 5 years was similar between upfront-surgery and TARE-surgery patients (83.0%, 60.0%, 47% vs. 94.0%, 86.0%, 55.0%, P =0.43) and compared favourably with TARE-only patients (61.0%, 16.0% and 9.0%, P <0.0001). After PSM, TARE-surgery patients had significantly better OS than Upfront-surgery patients ( P =0.021) while DFS was similar ( P =0.29). Conclusions: TARE may be a useful downstaging treatment for unresectable localized single large HCC providing comparable short and long-term outcomes with readily resectable tumours.