Abbott Andrea M, Kim Richard, Hoffe Sarah E, Arslan Bulent, Biebel Ben, Choi Junsung, El-Haddad Ghassan, Kis Bela, Sweeney Jennifer, Meredith Kenneth L, Almhanna Khaldoun, Strosberg Jonathan, Shibata David, Fulp William J, Shridhar Ravi
Department of Surgery, Moffitt Cancer Center, Tampa, FL.
Department of Medical Oncology, Moffitt Cancer Center, Tampa, FL.
Clin Colorectal Cancer. 2015 Sep;14(3):146-53. doi: 10.1016/j.clcc.2015.02.002. Epub 2015 Feb 16.
The liver is the most common site for colorectal cancer (CRC) metastases. Radioembolization with yttrium-90 (Y90) represents an alternative approach in the management of unresectable hepatic colorectal metastases. The objective of this study was to evaluate outcomes after treatment with Y90.
A retrospective review of patients undergoing Y90 glass microsphere treatment for metastatic CRC from 2009 to 2013 was conducted. Multivariable analysis (MVA) of factors related to overall survival (OS) was performed using the Cox proportional hazard and OS estimates were calculated using the Kaplan-Meier method.
We identified 68 patients. Median and 2-year OS were 11.6 months and 34%. For patients with ≤ 25% hepatic burden of disease (HBD) and 1 chemotherapy regimen, 2-year OS was 63%. Median and 2-year OS for patients with ≤ 25% versus > 25% HBD were 19.6 months and 42% versus 3.4 months and 0% (P < .0001). Univariate analysis revealed that higher HBD, ≥ 3 lines of chemotherapy received, and higher carcinoembryonic antigen (CEA) were found to be significant predictors of worse OS. MVA revealed age, > 25% HBD, ≥ 3 lines of chemotherapy, and higher CEA were independently prognostic for increased mortality, and resected status of the primary tumor was associated with decreased mortality. The presence of extrahepatic metastases was not prognostic. Toxicities were mild and only 5 patients experienced Grade 3/4 biochemical toxicity.
Yttrium-90 was associated with acceptable OS with minimal morbidity in this series. Minimal exposure to chemotherapy and low HBD were found to be associated with better OS, however, even patients with chemotherapy-refractory disease received a benefit from treatment.
肝脏是结直肠癌（CRC）转移最常见的部位。钇-90（Y90）放射性栓塞是治疗不可切除的肝结直肠癌转移的一种替代方法。本研究的目的是评估Y90治疗后的结果。
对2009年至2013年接受Y90玻璃微球治疗转移性CRC的患者进行回顾性研究。使用Cox比例风险模型对与总生存期（OS）相关的因素进行多变量分析（MVA），并使用Kaplan-Meier方法计算OS估计值。
我们确定了68例患者。中位OS和2年OS分别为11.6个月和34%。对于肝脏疾病负担（HBD）≤25%且接受1种化疗方案的患者，2年OS为63%。HBD≤25%与>25%的患者，中位OS和2年OS分别为19.6个月和42%，以及3.4个月和0%（P<.0001）。单变量分析显示，较高的HBD、接受≥3线化疗以及较高的癌胚抗原（CEA）是OS较差的显著预测因素。MVA显示，年龄、HBD>25%、≥3线化疗以及较高的CEA是死亡率增加的独立预后因素，原发肿瘤的切除状态与死亡率降低相关。肝外转移的存在不具有预后意义。毒性较轻，只有5例患者出现3/4级生化毒性。
在本系列研究中，钇-90与可接受的OS相关，发病率极低。发现最少的化疗暴露和低HBD与更好的OS相关，然而，即使是化疗难治性疾病的患者也从治疗中获益。
