Evaluation of Liver Biomarkers as Prognostic Factors for Outcomes to Yttrium-90 Radioembolization of Primary and Secondary Liver Malignancies

Yttrium-90 radioembolization for hepatocellular carcinoma: Outcome prediction with MRI derived fat-free muscle area

PURPOSE

Sarcopenia is associated with adverse outcomes in several gastrointestinal malignancies and liver cirrhosis. We aimed to study the utility of magnetic resonance imaging (MRI) derived fat-free muscle area (FFMA) to predict clinical outcome in patients receiving yttrium-90 radioembolization (RE) for treatment of hepatocellular carcinoma (HCC).

METHODS

Fifty-eight patients with unresectable HCC and pre-interventional liver MRI undergoing salvage RE were retrospectively evaluated. Using axial T2-weighted turbo spin echo sequences, FFMA was calculated by subtraction of the intramuscular adipose tissue area from the total cross-sectional area of paraspinal skeletal muscles at the superior mesenteric artery level. FFMA values lower than 3582 mm² in male and 2301 mm² in female patients were defined as low FFMA. Main outcomes were progression-free survival (PFS) and overall survival (OS). For outcome analysis, the Kaplan-Meier method with log rank test and multivariate cox regression analysis were used.

RESULTS

Mean time from pre-interventional MRI to RE was 27 ± 20 days. Median OS and PFS after RE were 250 (range: 21-1230 days) and 156 days (range: 21-674 days), respectively. Patients with low FFMA showed significantly reduced OS (197 vs. 294 days, P = 0.024) and tended to have shortened PFS (109 vs. 185 days, P = 0.068). Low FFMA (HR 2.675; P = 0.011), estimated liver tumor burden (HR 4.058; P = 0.001), and Eastern Cooperative Oncology Group (ECOG) performance status (1.763; P = 0.009) were independent predictors of OS on multivariate analysis.

CONCLUSIONS

FFMA as a measure of sarcopenia predicts OS and might represent a promising new biomarker for survival prognosis in patients undergoing RE for treatment of unresectable HCC.

Predictors of Survival after Yttrium-90 Radioembolization for Colorectal Cancer Liver Metastases

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.

Predictors and prognosticators for survival with Yttrium-90 radioembolization therapy for unresectable colorectal cancer liver metastasis

This critical review aims to explore predictive and prognostic biomarkers of Yttrium-90 (Y90) radioembolization therapy of colorectal liver metastases. A brief overview of established predictive and prognostic molecular and genetic biomarkers in colorectal cancer therapies will be discussed. A review of the literature on imaging modalities, genetic, metabolic and other molecular markers and the subsequent outcomes in post-Y90 treatment will be presented. How these biomarkers and future biomarker research can inform locoregional treatment decisions in the clinical setting of metastatic colorectal cancer lesions of the liver will be explored. There are opportunities for personalized cancer treatment in the setting of Y90 radioembolization. The ability to predict tumor response after Ytrium-90 radioembolization therapy can greatly impact clinical decision making and enhance treatment outcomes, therefore further research into the field is needed.

Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients

PURPOSE

To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE).

METHODS

We retrospectively analyzed the pre-therapeutic characteristics (sex, age, tumor entity, hepatic tumor burden, extrahepatic disease [EHD] and liver function [with focus on bilirubin and cholinesterase level]) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma [HCC], cholangiocarcinoma [CCC], neuroendocrine tumor [NET], colorectal cancer [CRC] and metastatic breast cancer [MBC]), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival.

RESULTS

The median OS was 356 days (95% CI 285-427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (P < 0.001), large tumor burden (P = 0.001), high bilirubin levels (>1.9 mg/dL, P < 0.001) and low cholinesterase levels (CHE <4.62 U/I, P < 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS.

CONCLUSIONS

Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.