Diagnostic Imaging, Inc., Aria Health Hospitals, Philadelphia, Pennsylvania, USA.
J Vasc Interv Radiol. 2010 Jan;21(1):90-5. doi: 10.1016/j.jvir.2009.09.011. Epub 2009 Nov 25.
To identify key prognostic clinical and imaging variables in patients undergoing yttrium-90 radioembolization ((90)Y) for liver malignancies.
Patients with liver malignancies that progressed despite standard-of-care therapy were treated with (90)Y from 2002 to 2006. Baseline functional status, laboratory values, and diagnostic imaging were assessed before therapy. Imaging follow-up was performed 1 month after treatment and subsequently at 3-month intervals. Patients were followed for survival from the time of their first (90)Y treatment.
Patients with follow-up imaging after radioembolization (N = 130) were included in this analysis. Primary malignancies included colon, neuroendocrine, and others. The following clinical variables had a significant effect on survival on multivariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than 0 (hazard ratio [HR], 7.98; 95% CI, 3.98-16), hepatic tumor burden of 51%-75% (HR, 2.46; 95% CI, 1.01-6.02), bilirubin level greater than 1.3 mg/dL (HR, 2.60; 95% CI, 1.27-5.34), hepatic metastases from breast cancer (HR, 2.51; 95% CI, 1.13-5.61), response on imaging based on World Health Organization (WHO) criteria (HR, 0.48; 95% CI, 0.24-0.94), and lymphocyte depression (HR, 0.56; 95% CI, 0.31-0.96). Among patients with colorectal cancer metastases to the liver, the HR for survival on univariate analysis for responders compared with nonresponders (per WHO criteria) was 0.26 (95% CI, 0.10-0.69).
Cancer-related symptoms (ie, ECOG PS > 0), hepatic tumor burden greater than 50%, increased bilirubin levels, and hepatic metastases from breast cancer were found to be negative prognostic factors. Tumor response to therapy and lymphocyte depression were associated with favorable prognosis. Additionally, WHO response was identified to be a favorable prognostic factor in patients with colorectal cancer metastases. These findings may be useful when counseling patients regarding prognosis of their hepatic disease.
确定行钇-90 放射性栓塞术（90Y）治疗肝脏恶性肿瘤患者的关键预后临床和影像学变量。
2002 年至 2006 年期间，对标准治疗后进展的肝脏恶性肿瘤患者进行了 90Y 治疗。在治疗前评估了患者的基本功能状态、实验室值和诊断性影像学。治疗后 1 个月进行影像学随访，随后每 3 个月进行一次随访。患者的生存时间从首次 90Y 治疗开始计算。
在有放射性栓塞后随访影像学的患者中（N=130），进行了本分析。主要恶性肿瘤包括结肠癌、神经内分泌肿瘤和其他肿瘤。多变量分析显示以下临床变量对生存有显著影响：东部肿瘤协作组（ECOG）表现状态（PS）大于 0（风险比[HR]，7.98；95%置信区间[CI]，3.98-16）、肝脏肿瘤负荷 51%-75%（HR，2.46；95%CI，1.01-6.02）、胆红素水平大于 1.3mg/dL（HR，2.60；95%CI，1.27-5.34）、乳腺癌肝转移（HR，2.51；95%CI，1.13-5.61）、根据世界卫生组织（WHO）标准的影像学反应（HR，0.48；95%CI，0.24-0.94）和淋巴细胞减少（HR，0.56；95%CI，0.31-0.96）。在结直肠癌肝转移患者中，根据 WHO 标准，有反应者与无反应者（per WHO criteria）的生存单变量分析 HR 为 0.26（95%CI，0.10-0.69）。
发现与癌症相关的症状（即 ECOG PS > 0）、肝脏肿瘤负荷大于 50%、胆红素水平升高和乳腺癌肝转移是负预后因素。治疗后的肿瘤反应和淋巴细胞减少与预后良好相关。此外，在结直肠癌肝转移患者中，WHO 反应被确定为一个有利的预后因素。这些发现可能在向患者提供其肝脏疾病预后方面有用。
