ArticleAnnals of nuclear medicine2026
Elevated baseline C-reactive protein is associated with treatment failure and shorter survival after Yttrium-90 radioembolization in hepatocellular carcinoma.
Article in Annals of nuclear medicine, 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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Abstract
objectiveTo evaluate the impact of baseline C-reactive protein (CRP) on outcomes after yttrium-90 (Y-90) radioembolization (RE) for hepatocellular carcinoma (HCC).
methodsThis retrospective study included patients with HCC treated with Y-90 RE at a tertiary center (June 2022-June 2025). Dosimetry was based on 99mTc-MAA SPECT/CT with refined post hoc high-dose definitions. High-dose therapy was defined as tumor-absorbed dose > 250 Gy for lobar treatments (glass or resin). For segmentectomy, high dose was defined as perfused-liver absorbed dose > 400 Gy for glass and > 250 Gy for resin microspheres. Patients were stratified by baseline CRP: low (≤ 1 mg/dL) vs. high (> 1 mg/dL). Tumor response was assessed on gadoxetate-enhanced MRI using mRECIST. Local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were estimated by Kaplan-Meier and compared with log-rank tests. Cox regression identified independent prognostic factors.
resultsThe cohort comprised 103 patients (mean age 65.8 ± 9 years; 76.7% male). BCLC stages were A (n = 27), B (n = 35), and C (n = 41); median largest tumor diameter was 6.0 cm (IQR 4.1-8.8), and median follow-up was 26 months. On multivariable analysis, CRP > 1 mg/dL independently predicted inferior LPFS (HR 3.6, p < 0.001), PFS (HR 2.7, p = 0.002), and OS (HR 4.8, p < 0.001). High-dose treatment was independently associated with improved LPFS (HR 0.55, p = 0.043) and OS (HR 0.47, p = 0.021). In subgroup analyses, high-dose treatment was associated with longer survival in the low-CRP group but not in the high-CRP group.
conclusionBaseline CRP > 1 mg/dL is a strong adverse prognostic factor after Y-90 RE. High-dose RE was associated with longer survival in patients with low CRP but not in those with elevated CRP; this hypothesis-generating observation requires prospective confirmation.
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