Transarterial Yttrium-90 Radioembolization in Intrahepatic Cholangiocarcinoma Patients: Outcome Assessment Applying a Prognostic Score

SIMPLE SUMMARY: Radioembolization (RE) for intrahepatic cholangiocarcinoma (ICC) is a viable treatment option. As the overall survival (OS) is subject to considerable variance, proper patient selection is of the utmost importance. The current study elucidated overall survival (time from treatment to the patient’s death) in 39 patients after RE in ICC. Out of all the investigated parameters, we identified three pre-therapeutic parameters which were able to predict both OS and patient prognosis by means of a score. More specifically, stratification of the patient cohort by pre-therapeutic GGT, clinical performance status (ECOG) and albumin resulted in significant differences regarding OS (0 risk factors, 15.3 months; 1 risk factor, 7.6 months; ≥2 risk factors, 1.8 months, respectively). Consequently, implementation of this proposed prognostic score may facilitate pre-therapeutic identification of patients who could benefit from RE in ICC. ABSTRACT: Radioembolization (RE) is a viable therapy option in patients with intrahepatic cholangiocarcinoma (ICC). This study delineates a prognostic score regarding overall survival (OS) after RE using routine pre-therapeutic parameters. A retrospective analysis of 39 patients (median age, 61 [range, 32–82] years; 26 females, 13 males) with ICC and 42 RE procedures was conducted. Cox regression for OS included age, ECOG, hepatic and extrahepatic tumor burden, thrombosis of the portal vein, ascites, laboratory parameters and dose reduction due to hepatopulmonary shunt. Median OS after RE was 8.0 months. Using univariable Cox, ECOG ≥ 1 (hazard ratio [HR], 3.8), AST/ALT quotient (HR, 1.86), high GGT (HR, 1.002), high CA19-9 (HR, 1.00) and dose reduction of 40% (HR, 3.8) predicted shorter OS (each p < 0.05). High albumin predicted longer OS (HR, 0.927; p = 0.045). Multivariable Cox confirmed GGT ≥ 750 [U/L] (HR, 7.84; p < 0.001), ECOG > 1 (HR, 3.76; p = 0.021), albumin ≤ 41.1 [g/L] (HR, 3.02; p = 0.006) as a three-point pre-therapeutic prognostic score. More specifically, median OS decreased from 15.3 months (0 risk factors) to 7.6 months (1 factor) or 1.8 months (≥2 factors; p < 0.001). The proposed score may aid in improved pre-therapeutic patient identification with (un-)favorable OS after RE and facilitate the balance between potential life prolongation and overaggressive patient selection.