Embolotherapy for Neuroendocrine Tumor Liver Metastases: Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival

James X. Chen, Steven Rose, Sarah B. White, Ghassan El-Haddad, Nicholas Fidelman, Hooman Yarmohammadi, Winifred Hwang, Daniel Y. Sze, Nishita Kothary, Kristen Stashek, E. Paul Wileyto, Riad Salem, David C. Metz, Michael C. Soulen*

*Corresponding author for this work

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose: The purpose of the study was to evaluate prognostic factors for survival outcomes following embolotherapy for neuroendocrine tumor (NET) liver metastases. Materials and Methods: This was a multicenter retrospective study of 155 patients (60 years mean age, 57 % male) with NET liver metastases from pancreas (n = 71), gut (n = 68), lung (n = 8), or other/unknown (n = 8) primary sites treated with conventional transarterial chemoembolization (TACE, n = 50), transarterial radioembolization (TARE, n = 64), or transarterial embolization (TAE, n = 41) between 2004 and 2015. Patient-, tumor-, and treatment-related factors were evaluated for prognostic effect on hepatic progression-free survival (HPFS) and overall survival (OS) using unadjusted and propensity score-weighted univariate and multivariate Cox proportional hazards models. Results: Median HPFS and OS were 18.5 and 125.1 months for G1 (n = 75), 12.2 and 33.9 months for G2 (n = 60), and 4.9 and 9.3 months for G3 tumors (n = 20), respectively (p < 0.05). Tumor burden >50 % hepatic volume demonstrated 5.5- and 26.8-month shorter median HPFS and OS, respectively, versus burden ≤50 % (p < 0.05). There were no significant differences in HPFS or OS between gut or pancreas primaries. In multivariate HPFS analysis, there were no significant differences among embolotherapy modalities. In multivariate OS analysis, TARE had a higher hazard ratio than TACE (unadjusted Cox model: HR 2.1, p = 0.02; propensity score adjusted model: HR 1.8, p = 0.11), while TAE did not differ significantly from TACE. Conclusion: Higher tumor grade and tumor burden prognosticated shorter HPFS and OS. TARE had a higher hazard ratio for OS than TACE. There were no significant differences in HPFS among embolotherapy modalities.

Original languageEnglish (US)
Pages (from-to)69-80
Number of pages12
JournalCardioVascular and Interventional Radiology
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Therapeutic Embolization
Neuroendocrine Tumors
Disease-Free Survival
Neoplasm Metastasis
Survival
Liver
Propensity Score
Survival Analysis
Proportional Hazards Models
Pancreas
Neoplasms
Tumor Burden
Multicenter Studies
Retrospective Studies

Keywords

  • Embolization
  • Liver metastases
  • Neuroendocrine tumor

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Chen, James X. ; Rose, Steven ; White, Sarah B. ; El-Haddad, Ghassan ; Fidelman, Nicholas ; Yarmohammadi, Hooman ; Hwang, Winifred ; Sze, Daniel Y. ; Kothary, Nishita ; Stashek, Kristen ; Wileyto, E. Paul ; Salem, Riad ; Metz, David C. ; Soulen, Michael C. / Embolotherapy for Neuroendocrine Tumor Liver Metastases : Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival. In: CardioVascular and Interventional Radiology. 2017 ; Vol. 40, No. 1. pp. 69-80.
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title = "Embolotherapy for Neuroendocrine Tumor Liver Metastases: Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival",
abstract = "Purpose: The purpose of the study was to evaluate prognostic factors for survival outcomes following embolotherapy for neuroendocrine tumor (NET) liver metastases. Materials and Methods: This was a multicenter retrospective study of 155 patients (60 years mean age, 57 {\%} male) with NET liver metastases from pancreas (n = 71), gut (n = 68), lung (n = 8), or other/unknown (n = 8) primary sites treated with conventional transarterial chemoembolization (TACE, n = 50), transarterial radioembolization (TARE, n = 64), or transarterial embolization (TAE, n = 41) between 2004 and 2015. Patient-, tumor-, and treatment-related factors were evaluated for prognostic effect on hepatic progression-free survival (HPFS) and overall survival (OS) using unadjusted and propensity score-weighted univariate and multivariate Cox proportional hazards models. Results: Median HPFS and OS were 18.5 and 125.1 months for G1 (n = 75), 12.2 and 33.9 months for G2 (n = 60), and 4.9 and 9.3 months for G3 tumors (n = 20), respectively (p < 0.05). Tumor burden >50 {\%} hepatic volume demonstrated 5.5- and 26.8-month shorter median HPFS and OS, respectively, versus burden ≤50 {\%} (p < 0.05). There were no significant differences in HPFS or OS between gut or pancreas primaries. In multivariate HPFS analysis, there were no significant differences among embolotherapy modalities. In multivariate OS analysis, TARE had a higher hazard ratio than TACE (unadjusted Cox model: HR 2.1, p = 0.02; propensity score adjusted model: HR 1.8, p = 0.11), while TAE did not differ significantly from TACE. Conclusion: Higher tumor grade and tumor burden prognosticated shorter HPFS and OS. TARE had a higher hazard ratio for OS than TACE. There were no significant differences in HPFS among embolotherapy modalities.",
keywords = "Embolization, Liver metastases, Neuroendocrine tumor",
author = "Chen, {James X.} and Steven Rose and White, {Sarah B.} and Ghassan El-Haddad and Nicholas Fidelman and Hooman Yarmohammadi and Winifred Hwang and Sze, {Daniel Y.} and Nishita Kothary and Kristen Stashek and Wileyto, {E. Paul} and Riad Salem and Metz, {David C.} and Soulen, {Michael C.}",
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Chen, JX, Rose, S, White, SB, El-Haddad, G, Fidelman, N, Yarmohammadi, H, Hwang, W, Sze, DY, Kothary, N, Stashek, K, Wileyto, EP, Salem, R, Metz, DC & Soulen, MC 2017, 'Embolotherapy for Neuroendocrine Tumor Liver Metastases: Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival', CardioVascular and Interventional Radiology, vol. 40, no. 1, pp. 69-80. https://doi.org/10.1007/s00270-016-1478-z

Embolotherapy for Neuroendocrine Tumor Liver Metastases : Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival. / Chen, James X.; Rose, Steven; White, Sarah B.; El-Haddad, Ghassan; Fidelman, Nicholas; Yarmohammadi, Hooman; Hwang, Winifred; Sze, Daniel Y.; Kothary, Nishita; Stashek, Kristen; Wileyto, E. Paul; Salem, Riad; Metz, David C.; Soulen, Michael C.

In: CardioVascular and Interventional Radiology, Vol. 40, No. 1, 01.01.2017, p. 69-80.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Embolotherapy for Neuroendocrine Tumor Liver Metastases

T2 - Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival

AU - Chen, James X.

AU - Rose, Steven

AU - White, Sarah B.

AU - El-Haddad, Ghassan

AU - Fidelman, Nicholas

AU - Yarmohammadi, Hooman

AU - Hwang, Winifred

AU - Sze, Daniel Y.

AU - Kothary, Nishita

AU - Stashek, Kristen

AU - Wileyto, E. Paul

AU - Salem, Riad

AU - Metz, David C.

AU - Soulen, Michael C.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Purpose: The purpose of the study was to evaluate prognostic factors for survival outcomes following embolotherapy for neuroendocrine tumor (NET) liver metastases. Materials and Methods: This was a multicenter retrospective study of 155 patients (60 years mean age, 57 % male) with NET liver metastases from pancreas (n = 71), gut (n = 68), lung (n = 8), or other/unknown (n = 8) primary sites treated with conventional transarterial chemoembolization (TACE, n = 50), transarterial radioembolization (TARE, n = 64), or transarterial embolization (TAE, n = 41) between 2004 and 2015. Patient-, tumor-, and treatment-related factors were evaluated for prognostic effect on hepatic progression-free survival (HPFS) and overall survival (OS) using unadjusted and propensity score-weighted univariate and multivariate Cox proportional hazards models. Results: Median HPFS and OS were 18.5 and 125.1 months for G1 (n = 75), 12.2 and 33.9 months for G2 (n = 60), and 4.9 and 9.3 months for G3 tumors (n = 20), respectively (p < 0.05). Tumor burden >50 % hepatic volume demonstrated 5.5- and 26.8-month shorter median HPFS and OS, respectively, versus burden ≤50 % (p < 0.05). There were no significant differences in HPFS or OS between gut or pancreas primaries. In multivariate HPFS analysis, there were no significant differences among embolotherapy modalities. In multivariate OS analysis, TARE had a higher hazard ratio than TACE (unadjusted Cox model: HR 2.1, p = 0.02; propensity score adjusted model: HR 1.8, p = 0.11), while TAE did not differ significantly from TACE. Conclusion: Higher tumor grade and tumor burden prognosticated shorter HPFS and OS. TARE had a higher hazard ratio for OS than TACE. There were no significant differences in HPFS among embolotherapy modalities.

AB - Purpose: The purpose of the study was to evaluate prognostic factors for survival outcomes following embolotherapy for neuroendocrine tumor (NET) liver metastases. Materials and Methods: This was a multicenter retrospective study of 155 patients (60 years mean age, 57 % male) with NET liver metastases from pancreas (n = 71), gut (n = 68), lung (n = 8), or other/unknown (n = 8) primary sites treated with conventional transarterial chemoembolization (TACE, n = 50), transarterial radioembolization (TARE, n = 64), or transarterial embolization (TAE, n = 41) between 2004 and 2015. Patient-, tumor-, and treatment-related factors were evaluated for prognostic effect on hepatic progression-free survival (HPFS) and overall survival (OS) using unadjusted and propensity score-weighted univariate and multivariate Cox proportional hazards models. Results: Median HPFS and OS were 18.5 and 125.1 months for G1 (n = 75), 12.2 and 33.9 months for G2 (n = 60), and 4.9 and 9.3 months for G3 tumors (n = 20), respectively (p < 0.05). Tumor burden >50 % hepatic volume demonstrated 5.5- and 26.8-month shorter median HPFS and OS, respectively, versus burden ≤50 % (p < 0.05). There were no significant differences in HPFS or OS between gut or pancreas primaries. In multivariate HPFS analysis, there were no significant differences among embolotherapy modalities. In multivariate OS analysis, TARE had a higher hazard ratio than TACE (unadjusted Cox model: HR 2.1, p = 0.02; propensity score adjusted model: HR 1.8, p = 0.11), while TAE did not differ significantly from TACE. Conclusion: Higher tumor grade and tumor burden prognosticated shorter HPFS and OS. TARE had a higher hazard ratio for OS than TACE. There were no significant differences in HPFS among embolotherapy modalities.

KW - Embolization

KW - Liver metastases

KW - Neuroendocrine tumor

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