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

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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.

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Author information

Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St, Philadelphia, PA, 19104, USA

    James X. Chen & Michael C. Soulen

  2. Division of Interventional Radiology, Department of Radiology, University of San Diego Medical Center, 200 W Arbor Dr, San Diego, CA, 92103, USA

    Steven Rose

  3. Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Sarah B. White

  4. Division of Interventional Radiology, Department of Radiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Ghassan El-Haddad

  5. Division of Interventional Radiology, Department of Radiology, University of San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA

    Nicholas Fidelman

  6. Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Hooman Yarmohammadi

  7. Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA, 94305, USA

    Winifred Hwang, Daniel Y. Sze & Nishita Kothary

  8. Department of Pathology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA

    Kristen Stashek

  9. Department of Biostatistics and Epidemiology, University of Pennsylvania, 432 Guardian Ave, Philadelphia, PA, 19104, USA

    E. Paul Wileyto

  10. Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, 251 East Huron, Chicago, IL, 60611, USA

    Riad Salem

  11. Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    David C. Metz

Authors
  1. James X. Chen
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  2. Steven Rose
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  14. Michael C. Soulen
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Corresponding author

Correspondence to Michael C. Soulen.

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Conflict of Interest

Steven C. Rose: consultant—SIRTeX; scientific advisory board—Surefire Medical. Sarah B. White: consultant—Guerbet, IO-rad, Grants—RSNA, SIR foundation, research support—Siemens. Nicholas Fidelman: Grants: BTG, GE Healthcare, Nordion. Daniel Y. Sze: consultant—Amgen, BTG, SirTeX Medical, W.L. Gore & Associates, Covidien, Guerbet, Cook, Codman; scientific advisory board—SureFire Medical, KoliMedical, Northwind Medical, TreusMedical, RadiAction Medical, EmboIX, Lunar Design, Jennerex Biotherapeutics. Riad Salem: consultant: BTG. David C. Metz MD: grants—Ipsen, Lexicon, AAA; consultant—Novartis, Takeda. Michael C. Soulen: grants—BTG, Guerbet; consultant—Guerbet, Merit. James X. Chen, Ghassan El-Haddad, Hooman Yarmohammadi, Winifred Hwang, Nishita Kothary, Kristen Stashek, E. Paul Wileyto, No disclosures.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Additional information

This study was selected as a Poster on Stage abstract for the CIRSE 2016 Annual Scientific Meeting.

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Chen, J.X., Rose, S., White, S.B. et al. Embolotherapy for Neuroendocrine Tumor Liver Metastases: Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival. Cardiovasc Intervent Radiol 40, 69–80 (2017). https://doi.org/10.1007/s00270-016-1478-z

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  • DOI: https://doi.org/10.1007/s00270-016-1478-z

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