Paprottka K J, Schoeppe F, Ingrisch M, Rübenthaler J, Sommer N N, De Toni E, Ilhan H, Zacherl M, Todica A, Paprottka P M
Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
Department of Hepatology, LMU - University of Munich, Munich, Germany.
Eur J Nucl Med Mol Imaging. 2017 Jul;44(7):1185-1193. doi: 10.1007/s00259-017-3646-z. Epub 2017 Feb 14.
To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE).
We retrospectively analyzed the pre-therapeutic characteristics (sex, age, tumor entity, hepatic tumor burden, extrahepatic disease [EHD] and liver function [with focus on bilirubin and cholinesterase level]) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma [HCC], cholangiocarcinoma [CCC], neuroendocrine tumor [NET], colorectal cancer [CRC] and metastatic breast cancer [MBC]), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival.
The median OS was 356 days (95% CI 285-427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (P < 0.001), large tumor burden (P = 0.001), high bilirubin levels (>1.9 mg/dL, P < 0.001) and low cholinesterase levels (CHE <4.62 U/I, P < 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS.
Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.
确定钇（Y）-90放射性栓塞（RE）后总生存期（OS）的治疗前预测因素。
我们回顾性分析了389例连续性患有各种难治性以肝脏为主的肿瘤（肝细胞癌[HCC]、胆管癌[CCC]、神经内分泌肿瘤[NET]、结直肠癌[CRC]和转移性乳腺癌[MBC]）患者的治疗前特征（性别、年龄、肿瘤类型、肝脏肿瘤负荷、肝外疾病[EHD]和肝功能[重点关注胆红素和胆碱酯酶水平]），这些患者接受Y-90放射性栓塞以预测生存期。通过单因素Cox回归分析选择预测因素，随后通过多因素分析检验其对患者生存的预测作用。
中位总生存期为356天（95%可信区间285 - 427天）。132例患者病情稳定，71例有客观缓解（其中1例为完全缓解），122例病情进展。NET患者的生存率最高，MBC患者的生存率最低。在单因素分析中，基线时的肝外疾病（P < 0.001）、大肿瘤负荷（P = 0.001）、高胆红素水平（>1.9 mg/dL，P < 0.001）和低胆碱酯酶水平（CHE <4.62 U/I，P < 0.001）与不良生存显著相关。在多因素分析中，肿瘤类型、肿瘤负荷、肝外疾病和CHE被确认为生存的独立预测因素。性别、应用的RE剂量和年龄对总生存期无显著影响。
治疗前基线胆红素和CHE水平、肝外疾病和肝脏肿瘤负荷与RE后的患者生存相关。这些参数可用于改善原发性或转移性肝肿瘤RE的患者选择。
