Sommer Wieland H, Ceelen Felix, García-Albéniz Xabier, Paprottka Philipp M, Auernhammer Christoph J, Armbruster Marco, Nikolaou Konstantin, Haug Alexander R, Reiser Maximilian F, Theisen Daniel
Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany,
Eur Radiol. 2013 Nov;23(11):3094-103. doi: 10.1007/s00330-013-2925-8. Epub 2013 Jun 28.
To define predictive parameters of long progression-free survival (PFS) in patients undergoing radioembolisation of neuroendocrine liver metastases.
The following clinical and magnetic resonance imaging (MRI) parameters of 45 radioembolised patients (median age, 62 years; range, 43-75) were reviewed: age, gender, levels of chromogranin A and neuron-specific enolase (NSE), primary tumour site, Ki-67 proliferation index, hepatic tumour load, number of metastases, signal intensity characteristics, vascularisation, haemorrhagic and necrotic transformation and fluid-fluid levels. PFS was assessed according to RECIST 1.0. Statistical analysis included univariate Cox regression, Kaplan-Meier and multivariate regression.
Median PFS was 727 days (95 % CI, 378-964). In the univariate regression analysis, hypovascular metastases progressed earlier (111 vs 727 days; P < 0.05). A Ki-67 ≤2 % was associated with a longer PFS than a Ki-67 of 3-20 % or >20 % (911 vs 727 vs 210 days, respectively; P < 0.05). Low NSE predicted longer PFS (911 vs 378 days; P < 0.05). In the adjusted multivariate analysis, vascularisation (hypervascularisation vs. no hypervascularisation; P = 0.0009) and NSE level (low vs high; P = 0.0119) had the strongest influence on PFS.
Response to radioembolisation in patients with neuroendocrine liver metastases can be predicted by the metastatic vascularisation pattern, the NSE level and the Ki-67.
• Radioembolisation is an effective treatment in hepatic metastases of neuroendocrine origin. • Pre-therapeutic vascularisation patterns of metastases on MRI can predict long progression-free survival. • Assessment of pre-therapeutic markers provides better therapy planning.
确定接受神经内分泌肝转移瘤放射性栓塞治疗患者长期无进展生存期（PFS）的预测参数。
回顾了45例接受放射性栓塞治疗患者（中位年龄62岁；范围43 - 75岁）的以下临床和磁共振成像（MRI）参数：年龄、性别、嗜铬粒蛋白A和神经元特异性烯醇化酶（NSE）水平、原发肿瘤部位、Ki-67增殖指数、肝肿瘤负荷、转移灶数量、信号强度特征、血管化、出血和坏死转化以及液-液平面。根据RECIST 1.0评估PFS。统计分析包括单因素Cox回归、Kaplan-Meier分析和多因素回归分析。
中位PFS为727天（95%CI，378 - 964）。在单因素回归分析中，乏血管转移瘤进展较早（111天对727天；P < 0.05）。Ki-67≤2%与Ki-67为3 - 20%或>20%相比，PFS更长（分别为911天对727天对210天；P < 0.05）。低NSE预测PFS更长（911天对378天；P < 0.05）。在调整后的多因素分析中，血管化（富血管化对无富血管化；P = 0.0009）和NSE水平（低对高；P = 0.0119）对PFS影响最大。
神经内分泌肝转移瘤患者对放射性栓塞治疗的反应可通过转移瘤的血管化模式、NSE水平和Ki-67来预测。
• 放射性栓塞是神经内分泌源性肝转移瘤的有效治疗方法。• MRI上转移瘤的治疗前血管化模式可预测长期无进展生存期。• 治疗前标志物评估可提供更好的治疗计划。
