Schatka Imke, Tschernig Monique, Rogasch Julian M M, Bluemel Stephanie, Graef Josefine, Furth Christian, Sehouli Jalid, Blohmer Jens-Uwe, Gebauer Bernhard, Fehrenbach Uli, Amthauer Holger
Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany.
Berlin Institute of Health (BIH), 10178 Berlin, Germany.
Cancers (Basel). 2021 Jul 27;13(15):3777. doi: 10.3390/cancers13153777.
Selective internal radiation therapy (SIRT) is a therapy option in patients with breast cancer liver metastasis (BCLM). This analysis aimed at identifying a prognostic score regarding overall survival (OS) after SIRT using routine pretherapeutic parameters. Retrospective analysis of 38 patients (age, 59 (39-84) years) with BCLM and 42 SIRT procedures. Cox regression for OS included clinical factors (age, ECOG and prior treatments), laboratory parameters, hepatic tumor load and dose reduction due to hepatopulmonary shunt. Elevated baseline ALT and/or AST was present if CTCAE grade ≥ 2 was fulfilled (>3 times the upper limit of normal). Median OS after SIRT was 6.4 months. In univariable Cox, ECOG ≥ 1 (hazard ratio (HR), 3.8), presence of elevated baseline ALT/AST (HR, 3.8), prior liver surgery (HR, 10.2), and dose reduction of 40% (HR, 8.1) predicted shorter OS (each < 0.05). Multivariable Cox confirmed ECOG ≥ 1 (HR, 2.34; = 0.012) and elevated baseline ALT/AST (HR, 4.16; < 0.001). Combining both factors, median OS decreased from 19.2 months (0 risk factors; = 14 procedures) to 5.9 months (1 factor; = 20) or 2.2 months (2 factors; = 8; < 0.001). The proposed score may facilitate pretherapeutic identification of patients with unfavorable OS after SIRT. This may help to balance potential life prolongation with the hazards of invasive treatment and hospitalization.
选择性内放射治疗（SIRT）是乳腺癌肝转移（BCLM）患者的一种治疗选择。本分析旨在利用常规治疗前参数确定SIRT后总生存期（OS）的预后评分。对38例BCLM患者（年龄59（39 - 84）岁）和42次SIRT治疗进行回顾性分析。OS的Cox回归分析纳入了临床因素（年龄、东部肿瘤协作组（ECOG）评分和既往治疗）、实验室参数、肝脏肿瘤负荷以及因肝肺分流导致的剂量减少。如果满足美国国立癌症研究所通用不良反应事件评价标准（CTCAE）≥2级（>正常上限3倍），则存在基线丙氨酸氨基转移酶（ALT）和/或天冬氨酸氨基转移酶（AST）升高。SIRT后的中位OS为6.4个月。在单变量Cox分析中，ECOG≥1（风险比（HR），3.8）、基线ALT/AST升高（HR，3.8）、既往肝脏手术（HR，10.2）以及剂量减少40%（HR，8.1）均提示OS较短（均P<0.05）。多变量Cox分析证实ECOG≥1（HR，2.34；P = 0.012）和基线ALT/AST升高（HR，4.16；P<0.001）。将这两个因素结合起来，中位OS从19.2个月（0个危险因素；n = 14例）降至5.9个月（1个因素；n = 20例）或2.2个月（2个因素；n = 8例；P<0.001）。所提出的评分可能有助于在治疗前识别SIRT后OS不良的患者。这可能有助于权衡潜在的生命延长与侵入性治疗和住院的风险。
