Ludwig Johannes M, Ambinder Emily McIntosh, Ghodadra Anish, Xing Minzhi, Prajapati Hasmukh J, Kim Hyun S
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
Department of Diagnostic Radiology, John Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD, 21287, USA.
Cardiovasc Intervent Radiol. 2016 Jul;39(7):1007-14. doi: 10.1007/s00270-016-1323-4. Epub 2016 Mar 10.
To investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival.
A single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients' baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low (<10 %) LSF. Baseline comparisons were performed using Fisher's exact tests for categorical and Mann-Whitney U test for continuous variables. Survival was calculated using the Kaplan-Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed.
There was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 %CI 12.73-55.23), with 4.77 months (95 %CI 2.87-26.73) for high and 42.77 months (95 %CI 18.47-59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival.
LSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.
研究钇 - 90（Y90）放射性栓塞治疗神经内分泌肿瘤肝转移（NETLMs）后的生存结局。本研究旨在评估Y90放射性栓塞的疗效，并评估肺分流分数（LSF）作为生存预测指标的价值。
对2006年至2012年间连续44例（中位年龄：58.5岁，29.5%为男性）诊断为胰腺（52.3%）或类癌（47.7%）NETLMs并接受Y90放射性栓塞治疗的患者进行单中心前瞻性研究。记录患者的基线特征，包括LSF和首次Y90放射性栓塞后的中位总生存期（OS），并在高LSF（≥10%）和低LSF（<10%）的患者之间进行比较。分类变量采用Fisher精确检验，连续变量采用Mann - Whitney U检验进行基线比较。采用Kaplan - Meier方法计算生存率。进行单因素（Wilcoxon秩和检验）和多因素分析（Cox比例风险模型）以进行危险因素分析。
高LSF（n = 15）和低LSF（n = 29）的患者在年龄、性别、种族、肿瘤特性或既往治疗方面无统计学显著差异。中位OS为27.4个月（95%CI 12.73 - 55.23），高LSF患者为4.77个月（95%CI 2.87 - 26.73），低LSF患者为42.77个月（95%CI 18.47 - 59.73）（p = 0.003）。多因素分析确定高LSF（p = 0.001）、总血清胆红素>1.2 mg（p = 0.016）以及未使用奥曲肽进行预处理（p = 0.01）是生存较差的独立预后因素。肿瘤类型和总辐射剂量不能预测生存。
发现LSF≥10%、胆红素水平升高以及未使用奥曲肽进行预处理是NETLMs患者生存较差的独立预后因素。
