| Affiliation: | 1. Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina;2. Department of Radiation Oncology, Washington University School of Medicine, 660 South Euclid Ave, St Louis, Missouri 63110;3. Department of Radiology, Washington University School of Medicine, 660 South Euclid Ave, St Louis, Missouri 63110;4. Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey;5. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey;6. Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;g. Department of Radiology, Jacobi Medical Center, Bronx, New York;h. Rutgers School of Public Health, New Brunswick, New Jersey;i. Department of Radiation Oncology, University of Colorado, Denver, Colorado |
| Abstract: | PurposeTo 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 MethodsA 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.ResultsThe 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).ConclusionsThe 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. |
