Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors - Variables affecting response rates and survival
Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors - Variables affecting response rates and survival
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作者：
Gupta, S;Johnson, MM;Yao, JC
背景本研究的目的是确定影响转移性神经内分泌肿瘤患者接受肝动脉栓塞（HAE）或化疗栓塞（HACE）治疗的疗效和生存率的预后变量。本回顾性研究纳入了接受HAE或HACE的转移性神经内分泌肿瘤患者。将随访影像学检查与基线影像学检查进行比较，以确定放射学反应。使用Kaplan-Meier方法计算无进展生存期（PFS）和总生存期（OS）。进行单变量和多变量分析，以评估影响疗效和生存率的预后变量。该研究包括69例类癌患者和54例胰岛细胞癌患者。与胰岛细胞癌患者相比，类癌患者的缓解率更高（66.7% vs. 35.2%; P = 0.0001），PFS（22.7个月vs. 16.1个月; P = 0.046）和OS（33.8个月vs. 23.2个月; P = 0.012）更长。对于类癌患者，多变量分析确定男性是生存不良的唯一独立危险因素（P = 0.05）。奥曲肽对PFS具有边缘预测性（P = 0.06）。接受HAE治疗的患者的缓解率高于接受HACE治疗的患者（P = 0.004）。对于胰岛细胞癌患者，在单变量分析中，原发肿瘤完整、肝脏受累≥ 75%和肝外转移与OS降低相关;在多变量分析中，骨转移是唯一的风险因素（P = 0.031）。与接受HAE治疗的患者相比，接受HACE治疗的患者OS延长（31.5个月vs. 18.2个月），缓解改善（50% vs. 25%），尽管差异未达到统计学显著性。类癌患者的预后优于胰岛细胞癌患者。在HAE基础上加用动脉内化疗并不能改善类癌患者的预后，但似乎对胰岛细胞癌患者有益。在类癌患者中，男性预测预后较差，在接受奥曲肽合并治疗的患者中观察到PFS延长的趋势。原发肿瘤完整、广泛性肝病和骨转移与胰岛细胞癌患者生存率降低相关。
BACKGROUND. The objective of this study was to determine the prognostic variables that influence response and survival in patients with metastatic neuroendocrine tumors who are treated with hepatic arterial embolization (HAE) or chemo-embolization (HACE).METHODS. Patients with metastatic neurcendocrine tumors who underwent HAE or HACE were included in this retrospective study. Follow-up imaging studies were compared with baseline imaging to determine the radiologic response. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to assess the prognostic variables that affected response and survival.RESULTS. The study included 69 patients with carcinoid tumors and 54 patients with pancreatic islet cell carcinomas. Patients who had carcinoid tumors had a higher response rate (66.7% vs. 35.2%; P = 0.0001) and had longer PFS (22.7 mos vs. 16.1 mos; P = 0.046) and OS (33.8 mos vs. 23.2 mos; P = 0.012) compared with patients who had islet cell carcinomas. For patients with carcinoid tumors, multivariate analysis identified male gender as the only independent risk factor for poor survival (P = 0.05). Octreotide was predictive marginally for PFS (P = 0.06). Patients who were treated with HAE had a higher response rate than patients who were treated with HACE (P = 0.004). For patients with islet cell carcinoma, an intact primary tumor, >= 75% liver involvement, and extrahepatic metastases were associated with reduced OS in the univariate analysis; the presence of bone metastases was the only risk factor (P = 0.031) in the multivariate analysis. Patients who were treated with HACE had a prolonged OS (31.5 mos vs. 18.2 mos) and improved response (50% vs. 25%) compared with patients who were treated with HAE, although the differences did not reach statistical significance.CONCLUSIONS. Patients with carcinoid tumors had better outcomes than patients with islet cell carcinomas. The addition of intraarterial chemotherapy to HAE did not improve the outcome of patients with carcinoid tumors, but it seemed to benefit patients with islet cell carcinomas. In patients who had carcinoid tumors, male gender predicted a poor outcome, and a trend toward prolonged PFS was observed in patients who received concomitant octreotide. An intact primary tumor, extensive liver disease, and bone metastases were associated with reduced survival in patients with islet cell carcinomas.