Ashley A Weiner1, Bin Gui2, Neil B Newman2, John L Nosher3, Fady Yousseff4, Shou-En Lu5, Gretchen M Foltz6, Darren Carpizo7, Jonathan Lowenthal3, Darryl A Zuckerman6, Ben Benson8, Jeffrey R Olsen9, Salma K Jabbour2, Parag J Parikh10. 1. Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 2. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. 3. Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. 4. Department of Radiation Oncology, Washington University School of Medicine, 660 South Euclid Ave, St Louis, Missouri 63110. 5. Rutgers School of Public Health, New Brunswick, New Jersey. 6. Department of Radiology, Washington University School of Medicine, 660 South Euclid Ave, St Louis, Missouri 63110. 7. Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. 8. Department of Radiology, Jacobi Medical Center, Bronx, New York. 9. Department of Radiation Oncology, University of Colorado, Denver, Colorado. 10. Department of Radiation Oncology, Washington University School of Medicine, 660 South Euclid Ave, St Louis, Missouri 63110. Electronic address: parikh@wustl.edu.
Abstract
PURPOSE: To identify clinical parameters that are prognostic for improved overall survival (OS) after yttrium-90 radioembolization (RE) in patients with liver metastases from colorectal cancer (CRC). MATERIALS AND METHODS: A total of 131 patients who underwent RE for liver metastases from CRC, treated at 2 academic centers, were reviewed. Twenty-one baseline pretreatment clinical factors were analyzed in relation to OS by the Kaplan-Meier method along with log-rank tests and univariate and multivariate Cox regression analyses. RESULTS: The median OS from first RE procedure was 10.7 months (95% confidence interval [CI], 9.4-12.7 months). Several pretreatment factors, including lower carcinoembryonic antigen (CEA; ≤20 ng/mL), lower aspartate transaminase (AST; ≤40 IU/L), neutrophil-lymphocyte ratio (NLR) <5, and absence of extrahepatic disease at baseline were associated with significantly improved OS after RE, compared with high CEA (>20 ng/mL), high AST (>40 IU/L), NLR ≥5, and extrahepatic metastases (P values of <.001, <.001, .0001, and .04, respectively). On multivariate analysis, higher CEA, higher AST, NLR ≥5, extrahepatic disease, and larger volume of liver metastases remained independently associated with risk of death (hazard ratios of 1.63, 2.06, 2.22, 1.48, and 1.02, respectively). CONCLUSIONS: The prognosis of patients with metastases from CRC is impacted by a complex set of clinical parameters. This analysis of pretreatment factors identified lower AST, lower CEA, lower NLR, and lower tumor burden (intra- or extrahepatic) to be independently associated with higher survival after hepatic RE. Optimal selection of patients with CRC liver metastases may improve survival rates after administration of yttrium-90.
PURPOSE: To identify clinical parameters that are prognostic for improved overall survival (OS) after yttrium-90 radioembolization (RE) in patients with liver metastases from colorectal cancer (CRC). MATERIALS AND METHODS: A total of 131 patients who underwent RE for liver metastases from CRC, treated at 2 academic centers, were reviewed. Twenty-one baseline pretreatment clinical factors were analyzed in relation to OS by the Kaplan-Meier method along with log-rank tests and univariate and multivariate Cox regression analyses. RESULTS: The median OS from first RE procedure was 10.7 months (95% confidence interval [CI], 9.4-12.7 months). Several pretreatment factors, including lower carcinoembryonic antigen (CEA; ≤20 ng/mL), lower aspartate transaminase (AST; ≤40 IU/L), neutrophil-lymphocyte ratio (NLR) <5, and absence of extrahepatic disease at baseline were associated with significantly improved OS after RE, compared with high CEA (>20 ng/mL), high AST (>40 IU/L), NLR ≥5, and extrahepatic metastases (P values of <.001, <.001, .0001, and .04, respectively). On multivariate analysis, higher CEA, higher AST, NLR ≥5, extrahepatic disease, and larger volume of liver metastases remained independently associated with risk of death (hazard ratios of 1.63, 2.06, 2.22, 1.48, and 1.02, respectively). CONCLUSIONS: The prognosis of patients with metastases from CRC is impacted by a complex set of clinical parameters. This analysis of pretreatment factors identified lower AST, lower CEA, lower NLR, and lower tumor burden (intra- or extrahepatic) to be independently associated with higher survival after hepatic RE. Optimal selection of patients with CRC liver metastases may improve survival rates after administration of yttrium-90.
Authors: Ieva Kurilova; Regina G H Beets-Tan; Jessica Flynn; Mithat Gönen; Gary Ulaner; Elena N Petre; F Edward Boas; Etay Ziv; Hooman Yarmohammadi; Elisabeth G Klompenhouwer; Andrea Cercek; Nancy A Kemeny; Constantinos T Sofocleous Journal: Clin Colorectal Cancer Date: 2018-09-13 Impact factor: 4.481
Authors: Florian Nima Fleckenstein; Maximilian Julius Roesel; Maja Krajewska; Timo Alexander Auer; Federico Collettini; Tazio Maleitzke; Georg Böning; Giovanni Federico Torsello; Uli Fehrenbach; Bernhard Gebauer Journal: Cancers (Basel) Date: 2021-12-24 Impact factor: 6.639