90-Day Hospitalization as a Surrogate for Overall Survival in Hepatocellular Carcinoma (HCC) Patients Treated With Magnetic Resonance-Guided Liver Stereotactic Body Radiation Therapy: Results of a Single-Center Retrospective Study.

PURPOSE/OBJECTIVE(S) With the increased utilization of stereotactic body radiation therapy (SBRT) for the management of hepatocellular carcinoma (HCC), it is important to have accurate prognostic factors for survival to guide treatment management decisions. Here, we examine 90-day hospitalization as a prognostic factor in addition to established staging systems including the albumin-bilirubin (ALBI) grade, Child-Pugh score, and Barcelona Clinic Liver Cancer (BCLC) stage. MATERIALS/METHODS This retrospective single-institution study analyzed 95 patients with HCC treated with SBRT from August 2017 to September 2020. Overall survival (OS) rates were retrospectively analyzed from treatment completion date to death date or last follow-up. Patients were censored from further analysis if subsequent SBRT courses were administered. Patient characteristics, 90-day hospitalization, ALBI grade, Child-Pugh score, and BCLC liver stage were analyzed with the Cox proportional hazard model and log-rank test; any significant factors on univariate analysis were subsequently analyzed in the multivariate analysis. RESULTS Median overall survival among the entire cohort was 67 months (range 0-38 months). Univariate predictors of overall survival included patient sex (P = 0.02), performance status (P = 0.03), Child-Pugh score (P = 0.003), ALBI grade (P < 0.0001), as well as 90-day hospitalization (P < 0.0001). However, 90-day hospitalization itself was associated with patient male gender (26.9% vs 7.1%; P = 0.03), performance status (P < 0.0001), Child-Pugh score (P = 0.003), ALBI grade (P = 0.003), and BCLC stage (P = 0.002). In the multivariate analysis, patient male sex (P = 0.02), ALBI grade 3 (P = 0.05), and 90-day hospitalization (P = 0.03) remained significant. CONCLUSION 90-day hospitalization is a significant predictor of overall survival among patients treated with SBRT for HCC. 90-day hospitalization could be used as an early endpoint in trials evaluating liver SBRT.