Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRB 290, Boston, MA 02114.
Present affiliation: Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston, MA.
AJR Am J Roentgenol. 2021 Nov;217(5):1141-1152. doi: 10.2214/AJR.20.25315. Epub 2021 Feb 17.
Primary colon cancer location affects survival of patients with metastatic colorectal cancer (mCRC). Outcomes based on primary tumor location after salvage hepatic radioembolization with Y resin microspheres are not well studied. The objectives of this study are to assess the survival outcomes of patients with advanced chemorefractory mCRC treated with Y radioembolization, as stratified by primary tumor location, and to explore potential factors that are predictive of survival. A total of 99 patients who had progressive mCRC liver metastases while receiving systemic therapy and who were treated with Y radioembolization at a single center were retrospectively analyzed. For 89 patients, tumor response on the first imaging follow-up examination (CT or MRI performed at a mean [± SD] of 1.9 ± 0.9 months after Y radioembolization) was evaluated using RECIST. Overall survival (OS), OS after Y radioembolization, and hepatic progression-free survival (PFS) were calculated using the Kaplan-Meier method. Outcomes and associations of outcomes with tumor response were compared between patients with left- and right-sided tumors. A total of 74 patients had left-sided colon cancer, and 25 patients had right-sided colon cancer. Median OS from the time of mCRC diagnosis was 37.2 months, median OS after Y radioembolization was 5.8 months, and median hepatic PFS was 3.3 months. Based on RECIST, progressive disease on first imaging follow-up was observed in 38 patients (43%) after Y radioembolization and was associated with shorter OS after Y radioembolization compared with observation of disease control on first imaging follow-up (4.0 vs 10.5 months; < .001). Patients with right-sided primary tumors showed decreased median OS after Y radioembolization compared with patients with left-sided primary tumors (5.4 vs 6.2 months; = .03). Right- and left-sided primary tumors showed no significant difference in RECIST tumor response, hepatic PFS, or extrahepatic disease progression ( > .05). Median survival after Y radioembolization was significantly lower among patients with progressive disease than among those with disease control in the group with left-sided primary tumors (4.2 vs 13.9 months; < .001); however, this finding was not observed in the group with right-sided primary tumors (3.3 vs 7.2 months; = .05). Right-sided primary tumors were independently associated with decreased survival among patients with chemorefractory mCRC after Y radioembolization, despite these patients having a similar RECIST tumor response, hepatic PFS, and extrahepatic disease progression compared with patients with left-sided primary tumors. Primary colon cancer location impacts outcomes after salvage Y radioembolization and may help guide patient selection.
原发性结肠癌部位影响转移性结直肠癌（mCRC）患者的生存。接受 Y 树脂微球挽救性肝动脉化疗栓塞后基于原发性肿瘤位置的生存结果尚未得到很好的研究。本研究的目的是评估在单个中心接受 Y 放射性栓塞治疗的晚期化疗耐药 mCRC 患者的生存结果，并探索预测生存的潜在因素。对 99 例在接受系统治疗时出现进展性 mCRC 肝转移且在单个中心接受 Y 放射性栓塞治疗的患者进行回顾性分析。对于 89 例患者，在 Y 放射性栓塞后 1.9±0.9 个月（平均[±标准差]）进行 CT 或 MRI 首次影像学随访检查时，采用 RECIST 评估肿瘤反应。使用 Kaplan-Meier 方法计算总生存期（OS）、Y 放射性栓塞后 OS 和肝无进展生存期（PFS）。比较左、右侧肿瘤患者的肿瘤反应与生存结局的相关性。共有 74 例患者为左侧结肠癌，25 例患者为右侧结肠癌。mCRC 诊断后的中位 OS 为 37.2 个月，Y 放射性栓塞后的中位 OS 为 5.8 个月，中位肝 PFS 为 3.3 个月。根据 RECIST，Y 放射性栓塞后首次影像学随访时观察到 38 例（43%）患者疾病进展，与首次影像学随访时观察到疾病控制相比，Y 放射性栓塞后的 OS 更短（4.0 个月与 10.5 个月；<.001）。与左侧原发性肿瘤患者相比，右侧原发性肿瘤患者的 Y 放射性栓塞后中位 OS 降低（5.4 个月与 6.2 个月；=0.03）。右、左侧原发性肿瘤在 RECIST 肿瘤反应、肝 PFS 或肝外疾病进展方面无显著差异（>.05）。在左侧原发性肿瘤组中，与疾病控制相比，疾病进展患者的 Y 放射性栓塞后中位生存时间显著降低（4.2 个月与 13.9 个月；<.001）；然而，在右侧原发性肿瘤组中，这一发现并不显著（3.3 个月与 7.2 个月；=0.05）。尽管右侧原发性肿瘤患者与左侧原发性肿瘤患者相比，在 Y 放射性栓塞后具有相似的 RECIST 肿瘤反应、肝 PFS 和肝外疾病进展，但右侧原发性肿瘤与 Y 放射性栓塞后化疗耐药 mCRC 患者的生存降低独立相关。原发性结肠癌部位影响挽救性 Y 放射性栓塞后的结局，可能有助于指导患者选择。
