Risk Stratification and Contemporary Predictors of Survival in Hepatocellular Carcinoma Treated With Transarterial Radioembolization

Background: Identifying risk factors for poor outcomes in patients with hepatocellular carcinoma (HCC) treated with transarterial radioemboli-zation (TARE) can aid in developing personalized management strate-gies, such as the early use of immune checkpoint inhibitors (ICIs). Results: We included 141 patients (median age of 65 years; 80% Caucasian; 80% male). Better PFS was associated with higher albumin (alb) (hazard ratio (HR) = 0.58, P = 0.005) and lower total bilirubin (T bili) levels (HR = 0.70, P = 0.034). Better OS was associated with a history of ablation (HR = 0.35, P < 0.001) and higher pre-TARE alb (HR = 0.63, P = 0.01); OS was worse in those with hepatic encephalopathy (HR = 2.01, P = 0.006). There was a notable trend toward worse OS in patients with ascites (HR = 1.71, P = 0.06) and metabolic-dysfunction-associated fatty liver disease (MAFLD)-associated HCC (HR = 1.86, P = 0.08). The receipt of ICI therapy was associated with a significantly better OS (P = 0.016), with a median OS of 1,102 days (95% confidence interval (CI): 884-1,509) compared to 614 days (95% CI: 493-829). Conclusion: We present pretreatment risk factors (low alb, high T bili, MAFLD, hepatic encephalopathy, and ascites) that can predict poor outcomes in HCC patients treated with TARE. Preemptively treating such high-risk patients with ICI could improve their outcomes.