ArticleJournal of hepatocellular carcinoma2026
Tumor Burden Thresholds Associated with Successful Downstaging After Yttrium-90 Radioembolization in Hepatocellular Carcinoma Beyond UCSF Criteria.
Article in Journal of hepatocellular carcinoma, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
Purpose: Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages, limiting access to curative therapies. Yttrium-90 (Y-90) trans-arterial radioembolization (TARE) has been used for tumor downstaging to enable surgical resection or liver transplantation; however, the factors associated with successful downstaging and potential selection thresholds remain unclear. Patients and Methods: We retrospectively analyzed 65 patients with unresectable HCC exceeding the University of California, San Francisco (UCSF) criteria who underwent Y-90 TARE between 2020 and 2024. Tumor burden parameters, dosimetric features, treatment response, overall survival (OS), and progression-free survival (PFS) were evaluated. Receiver operating characteristic (ROC) analysis was performed to identify exploratory thresholds associated with successful downstaging, and survival outcomes were assessed using Kaplan-Meier methods. Results: Down-staging to within UCSF criteria was achieved in 58.5% of patients. Successfully down-staged patients had significantly longer OS than non-downstaged patients (median OS, not reached vs. 18.8 months; p = 0.034). ROC analysis identified exploratory tumor burden thresholds associated with downstaging failure, including largest tumor diameter ≥7.8 cm, tumor volume ≥265 cm Conclusion: Y-90 TARE enables effective downstaging in a substantial proportion of patients with advanced HCC and may facilitate subsequent curative surgery or living donor liver transplantation. Tumor burden metrics and size-dependent T/N ratios were associated with successful downstaging and may assist patient selection for Y-90 TARE. These findings should be considered exploratory and warrant validation in larger prospective studies.
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