Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model
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To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolisation (cTACE), drug-eluting beads TACE (DEB-TACE) and yttrium-90 radioembolisation (Y90) for the treatment of liver metastases from gastroenteropancreatic (GEP) neuroendocrine tumours (NELM).
This retrospective analysis included 192 patients (58.6 years mean age, 56% men) with NELM treated with cTACE (N = 122), DEB-TACE (N = 26) or Y90 (N = 44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumours (RECIST) and World Health Organization (WHO) criteria using periprocedural MR imaging. Survival analysis included propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan–Meier using log-rank test and the uni- and multivariate Cox proportional hazards model (MVA).
MOS of the entire study population was 28.8 months. As for cTACE, DEB-TACE and Y90, MOS was 33.8 months, 21.7 months and 23.6 months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE (p <.01) or Y90 (p = .02). The 5-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively.
Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.
• cTACE achieved a significantly longer overall survival in patients with unresectable NELM.
• Patients treated with cTACE showed a prolonged hepatic progression-free survival.
• cTACE, DEB-TACE and Y90 radioembolisation demonstrated comparable safety and toxicity profiles.
• Age >70 years, extrahepatic metastases and tumour burden >50% were identified as negative predictors.
• Propensity score analysis suggests the superiority of cTACE over DEB-TACE and Y90.
KeywordsNeuroendocrine tumours Chemoembolisation Drug-eluting beads, DEB Yttrium-90 radioembolisation, Y90 Propensity score
Conventional transarterial chemoembolisation
Drug-eluting beads TACE
Hepatic progression-free survival
Median overall survival
NET liver metastases
Pancreatic NET (islet cell tumours)
Propensity score analysis
Response evaluation criteria in solid tumours
Liver tumour resection with curative intention
World Health Organization
We kindly thank Yanhong Deng, Biostatistician, School of Public Health: Yale Center for Analytical Sciences (YCAS), for the statistical review and technical support.
Compliance with ethical standards
The scientific guarantor of this publication is Jean-Francois Geschwind, M.D.
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Jean-François Geschwind, M.D.:
Consultant: Biocompatibles/BTG, Bayer HealthCare, Guerbet, Nordion/BTG, Philips Healthcare and Jennerex
Founder and CEO PreScience Labs, LLC.; MingDe Lin: Employee: Philips Research North America, Cambridge, MA.
This study has received funding by
NIH/NCI (R01 CA206180), NIH/NCI (R01 CA160771): Prof. Dr. Jean-François Geschwind
Dr. MingDe Lin
Studienstiftung des Deutschen Volkes: Duc Do Minh
Rolf W. Günther Stiftung für Radiologische Wissenschaften: Duc Do Minh
Statistics and biometry
Yanhong Deng kindly provided statistical advice for this manuscript.
(Yanhong Deng, Biostatistician, School of Public Health: Yale Center for Analytical Sciences (YCAS))
Written informed consent was waived by the institutional review board.
Institutional review board approval was obtained.
• diagnostic or prognostic study and observational
• performed at one institution
- 18.Stone CA, Tang Y (2013) Comparing propensity score methods in balancing covariates and recovering impact in small sample educational program evaluations. Pract Assess Res Eval 18:12Google Scholar
- 19.Xie J, Liu C. Adjusted Kaplan–Meier estimator and log-rank test with inverse probability of treatment weighting for survival data. Stat Med 24:3089–110Google Scholar
- 20.Ridgeway G, McCaffrey DF, Morral AR, Burgette LF, Griffin BA (2014) Toolkit for weighting and analysis of nonequivalent groups (TWANG). RAND, Santa MonicaGoogle Scholar
- 21.Olmos A, Govindasamy P (2015) A practical guide for using propensity score weighting in R. Pract Assess Res Eval 20. http://pareonline.net/getvn.asp?v=20&n=13