Department of Diagnostic Radiology, Division of Interventional Radiology, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA 91010.
Surgery, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA 91010.
J Vasc Interv Radiol. 2021 Mar;32(3):393-402. doi: 10.1016/j.jvir.2020.10.019. Epub 2021 Jan 7.
To compare the outcomes of patients with gastrointestinal neuroendocrine tumor liver metastases treated with liver-directed therapy (LDT) to those treated with systemic therapy (ST) in a statewide cancer database.
A retrospective study was performed of patients with metastatic gastrointestinal tract neuroendocrine tumors treated with either LDT or ST alone between the years 2000-2012 in the California Cancer Registry. Overall survival and disease-specific survival were assessed using multivariable Cox proportional hazards analysis and propensity score matching.
A total of 154 patients (ST, n = 87 and LDT, n = 67) were studied. The median overall survival and disease-specific survival for patients that received ST was 29 and 35 months versus 51 and >60 months for patients that received LDT. On multivariate analysis, LDT and the resection of the primary tumor were associated with improved survival (hazard ratio [HR] 0.52, P = .002; HR 0.43, P = .001). Non-white race, Medicaid/uninsured status, and the presence of lung metastases were associated with poor survival (HR 1.76, P = .014; HR 2.29, P = .009; and HR 1.79, P = .031). Propensity score matching demonstrated an improvement in disease-specific survival for LDT compared to ST (HR 0.53, P = .036). The improvement in overall survival on propensity score matching did not achieve statistical significance (HR 0.70, P = .199).
LDT is associated with improved overall and disease-specific survival as compared to ST in patients with gastrointestinal neuroendocrine tumor liver metastases. Further investigation is needed to determine whether combination or sequential treatment can improve outcomes in this population.
在加利福尼亚癌症登记处的全州癌症数据库中，比较接受肝定向治疗（LDT）和全身治疗（ST）的胃肠道神经内分泌肿瘤肝转移患者的结局。
对 2000-2012 年间在加利福尼亚癌症登记处接受 LDT 或 ST 单一治疗的转移性胃肠道神经内分泌肿瘤患者进行回顾性研究。使用多变量 Cox 比例风险分析和倾向评分匹配评估总生存期和疾病特异性生存期。
共研究了 154 例患者（ST，n=87；LDT，n=67）。接受 ST 的患者的中位总生存期和疾病特异性生存期分别为 29 个月和 35 个月，而接受 LDT 的患者分别为 51 个月和>60 个月。多变量分析显示，LDT 和原发性肿瘤切除术与生存改善相关（风险比[HR]0.52，P=0.002；HR 0.43，P=0.001）。非白人种族、医疗补助/无保险状态和肺转移的存在与较差的生存相关（HR 1.76，P=0.014；HR 2.29，P=0.009；HR 1.79，P=0.031）。倾向评分匹配显示，与 ST 相比，LDT 可改善疾病特异性生存期（HR 0.53，P=0.036）。倾向评分匹配的总生存期改善未达到统计学意义（HR 0.70，P=0.199）。
与 ST 相比，LDT 可改善胃肠道神经内分泌肿瘤肝转移患者的总体和疾病特异性生存期。需要进一步研究以确定在该人群中联合或序贯治疗是否可以改善结局。
