Schatka Imke, Jochens Hans V, Rogasch Julian M M, Walter-Rittel Thula C, Pelzer Uwe, Benckert Julia, Graef Josefine, Feldhaus Felix W, Gebauer Bernhard, Amthauer Holger
Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
Cancers (Basel). 2022 Oct 29;14(21):5324. doi: 10.3390/cancers14215324.
Radioembolization (RE) is a viable therapy option in patients with intrahepatic cholangiocarcinoma (ICC). This study delineates a prognostic score regarding overall survival (OS) after RE using routine pre-therapeutic parameters. A retrospective analysis of 39 patients (median age, 61 [range, 32−82] years; 26 females, 13 males) with ICC and 42 RE procedures was conducted. Cox regression for OS included age, ECOG, hepatic and extrahepatic tumor burden, thrombosis of the portal vein, ascites, laboratory parameters and dose reduction due to hepatopulmonary shunt. Median OS after RE was 8.0 months. Using univariable Cox, ECOG ≥ 1 (hazard ratio [HR], 3.8), AST/ALT quotient (HR, 1.86), high GGT (HR, 1.002), high CA19-9 (HR, 1.00) and dose reduction of 40% (HR, 3.8) predicted shorter OS (each p < 0.05). High albumin predicted longer OS (HR, 0.927; p = 0.045). Multivariable Cox confirmed GGT ≥ 750 [U/L] (HR, 7.84; p < 0.001), ECOG > 1 (HR, 3.76; p = 0.021), albumin ≤ 41.1 [g/L] (HR, 3.02; p = 0.006) as a three-point pre-therapeutic prognostic score. More specifically, median OS decreased from 15.3 months (0 risk factors) to 7.6 months (1 factor) or 1.8 months (≥2 factors; p < 0.001). The proposed score may aid in improved pre-therapeutic patient identification with (un-)favorable OS after RE and facilitate the balance between potential life prolongation and overaggressive patient selection.
放射性栓塞（RE）是肝内胆管癌（ICC）患者一种可行的治疗选择。本研究利用常规治疗前参数描绘了RE后总生存期（OS）的预后评分。对39例ICC患者（中位年龄61岁[范围32 - 82岁]；26例女性，13例男性）及42次RE治疗进行了回顾性分析。OS的Cox回归分析纳入了年龄、东部肿瘤协作组（ECOG）体能状态评分、肝内和肝外肿瘤负荷、门静脉血栓形成、腹水、实验室参数以及因肝肺分流导致的剂量减少。RE后的中位OS为8.0个月。单变量Cox分析显示，ECOG≥1（风险比[HR]，3.8）、谷草转氨酶/谷丙转氨酶比值（HR，1.86）、高γ-谷氨酰转肽酶（GGT）（HR，1.002）、高糖类抗原19 - 9（CA19 - 9）（HR，1.00）以及40%的剂量减少（HR，3.8）提示OS较短（均p<0.05）。高白蛋白提示OS较长（HR，0.927；p = 0.045）。多变量Cox分析证实，GGT≥750[U/L]（HR，7.84；p<0.001）、ECOG>1（HR，3.76；p = 0.021）、白蛋白≤41.1[g/L]（HR，3.02；p = 0.006）作为三分治疗前预后评分。更具体地说，中位OS从15.3个月（0个危险因素）降至7.6个月（1个因素）或1.8个月（≥2个因素；p<0.001）。所提出的评分可能有助于改善治疗前对RE后OS有利或不利的患者识别，并有助于在潜在的延长生命和过度积极的患者选择之间取得平衡。
