From the Departments of Radiology (J.A., R.C., G.P., M.D., L.R., M.P.V., V.V., M.R.), Pancreatology and Digestive Oncology (L.d.M., O.H., P.R.), and Pathology (J.C.), Université de Paris, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France; Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (R.C., G.P.); Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy (R.C.); Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France (L.d.M., M.D., J.C., V.V., M.R.); Gustave Roussy, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Villejuif, France (L.T.); and Lausanne University Hospital and University of Lausanne, Department of Radiology and Interventional Radiology, Lausanne, Switzerland (R.D.).
Radiol Imaging Cancer. 2023 Jan;5(1):e220051. doi: 10.1148/rycan.220051.
Purpose To investigate whether liver enhancing tumor burden (LETB) assessed at contrast-enhanced CT indicates early response and helps predict survival outcomes in patients with multifocal neuroendocrine liver metastases (NELM) after intra-arterial treatment. Materials and Methods This retrospective study included patients with NELM who underwent intra-arterial treatment with transarterial embolization (TAE) or chemoembolization (TACE) between April 2006 and December 2018. Tumor response in treated NELM was evaluated by using the Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST). LETB was measured as attenuation 2 SDs greater than that of a region of interest in the nontumoral liver parenchyma. Overall survival (OS); time to unTA(C)Eable progression, defined as the time from the initial treatment until the time when intra-arterial treatments were considered technically unfeasible, either not recommended by the multidisciplinary tumor board or until death; and hepatic and whole-body progression-free survival (PFS) were evaluated using multivariable Cox proportional hazards analyses, the Kaplan-Meier method, and log-rank test. Results The study included 119 patients (mean age, 60 years ± 11 [SD]; 61 men) who underwent 161 treatments. A median LETB change of -25.8% best discriminated OS (83 months in responders vs 51 months in nonresponders; = .02) and whole-body PFS (18 vs 8 months, respectively; < .001). A -10% LETB change best discriminated time to unTA(C)Eable progression (32 months in responders vs 12 months in nonresponders; < .001) and hepatic PFS (18 vs 8 months, respectively; < .001). LETB change remained independently associated with improved OS (hazard ratio [HR], 0.56), time to unTA(C)Eable progression (HR, 0.44), hepatic PFS (HR, 0.42), and whole-body PFS (HR, 0.47) on multivariable analysis. Neither RECIST nor mRECIST helped predict patient outcome. Conclusion Response according to LETB change helped predict survival outcomes in patients with NELM after intra-arterial treatments, with better discrimination than RECIST and mRECIST. CT, Chemoembolization, Embolization, Abdomen/GI, Liver © RSNA, 2023.
目的 探讨对比增强 CT 评估的肝增强肿瘤负担（LETB）是否能反映早期应答，并有助于预测接受经动脉治疗的多发性神经内分泌肝脏转移瘤（NELM）患者的生存结局。
材料与方法 本回顾性研究纳入了 2006 年 4 月至 2018 年 12 月期间接受经动脉栓塞（TAE）或化疗栓塞（TACE）治疗的 NELM 患者。采用实体瘤反应评估标准（RECIST）和改良 RECIST（mRECIST）评估治疗后 NELM 的肿瘤应答。以感兴趣区（ROI）在非肿瘤性肝实质中的衰减值增加 2 个标准差来测量 LETB。采用多变量 Cox 比例风险分析、Kaplan-Meier 法和对数秩检验评估总生存期（OS）；无经动脉（TA）（C）E 治疗进展时间，定义为从初始治疗开始到多学科肿瘤委员会认为经动脉治疗技术上不可行的时间，或者不建议进行治疗，或者直至死亡；以及肝内和全身无进展生存期（PFS）。
结果 该研究纳入了 119 例患者（平均年龄 60 岁±11[标准差]；61 例男性），共进行了 161 次治疗。LETB 变化-25.8%可最佳区分 OS（应答者为 83 个月，无应答者为 51 个月； =.02）和全身 PFS（分别为 18 个月和 8 个月；<.001）。LETB 变化-10%可最佳区分无经动脉（TA）（C）E 治疗进展时间（应答者为 32 个月，无应答者为 12 个月；<.001）和肝内 PFS（分别为 18 个月和 8 个月；<.001）。多变量分析显示，LETB 变化与改善的 OS（危险比[HR]，0.56）、无经动脉（TA）（C）E 治疗进展时间（HR，0.44）、肝内 PFS（HR，0.42）和全身 PFS（HR，0.47）独立相关。RECIST 和 mRECIST 均无助于预测患者结局。
结论 根据 LETB 变化判断的应答有助于预测接受经动脉治疗的 NELM 患者的生存结局，其区分能力优于 RECIST 和 mRECIST。
