Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases

Single-Center Prospective Analysis

Johannes M. Ludwig, Emily Ambinder, Anish Ghodadra, Minzhi Xing, Hasmukh J. Prajapati, Hyun S. Kim

Research output: Contribution to journalArticle

Abstract

Objective: To investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival. Methods: A single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients’ baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low (<10 %) LSF. Baseline comparisons were performed using Fisher’s exact tests for categorical and Mann–Whitney U test for continuous variables. Survival was calculated using the Kaplan–Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed. Results: There was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 %CI 12.73–55.23), with 4.77 months (95 %CI 2.87–26.73) for high and 42.77 months (95 %CI 18.47–59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival. Conclusions: LSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.

Original languageEnglish (US)
Pages (from-to)1007-1014
Number of pages8
JournalCardioVascular and Interventional Radiology
Volume39
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Yttrium
Neoplasm Metastasis
Lung
Survival
Neuroendocrine Tumors
Liver
Octreotide
Carcinoid Tumor
Bilirubin
Prospective Studies
Radiation
Neoplasms

Keywords

  • Hepatopulmonary Shunt Fraction
  • Liver Metastases
  • Neuroendocrine Tumors
  • Survival Biomarker
  • Yttrium-90 Radioembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases : Single-Center Prospective Analysis. / Ludwig, Johannes M.; Ambinder, Emily; Ghodadra, Anish; Xing, Minzhi; Prajapati, Hasmukh J.; Kim, Hyun S.

In: CardioVascular and Interventional Radiology, Vol. 39, No. 7, 01.07.2016, p. 1007-1014.

Research output: Contribution to journalArticle

@article{865d8e4f26dd48acbb6f58fac216cfdd,
title = "Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases: Single-Center Prospective Analysis",
abstract = "Objective: To investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival. Methods: A single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 {\%} male) diagnosed with pancreatic (52.3 {\%}) or carcinoid (47.7 {\%}) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients’ baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 {\%}) and low (<10 {\%}) LSF. Baseline comparisons were performed using Fisher’s exact tests for categorical and Mann–Whitney U test for continuous variables. Survival was calculated using the Kaplan–Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed. Results: There was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 {\%}CI 12.73–55.23), with 4.77 months (95 {\%}CI 2.87–26.73) for high and 42.77 months (95 {\%}CI 18.47–59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival. Conclusions: LSF ≥10 {\%}, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.",
keywords = "Hepatopulmonary Shunt Fraction, Liver Metastases, Neuroendocrine Tumors, Survival Biomarker, Yttrium-90 Radioembolization",
author = "Ludwig, {Johannes M.} and Emily Ambinder and Anish Ghodadra and Minzhi Xing and Prajapati, {Hasmukh J.} and Kim, {Hyun S.}",
year = "2016",
month = "7",
day = "1",
doi = "10.1007/s00270-016-1323-4",
language = "English (US)",
volume = "39",
pages = "1007--1014",
journal = "CardioVascular and Interventional Radiology",
issn = "7415-5101",
publisher = "Springer Verlag",
number = "7",

}

TY - JOUR

T1 - Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases

T2 - Single-Center Prospective Analysis

AU - Ludwig, Johannes M.

AU - Ambinder, Emily

AU - Ghodadra, Anish

AU - Xing, Minzhi

AU - Prajapati, Hasmukh J.

AU - Kim, Hyun S.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Objective: To investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival. Methods: A single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients’ baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low (<10 %) LSF. Baseline comparisons were performed using Fisher’s exact tests for categorical and Mann–Whitney U test for continuous variables. Survival was calculated using the Kaplan–Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed. Results: There was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 %CI 12.73–55.23), with 4.77 months (95 %CI 2.87–26.73) for high and 42.77 months (95 %CI 18.47–59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival. Conclusions: LSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.

AB - Objective: To investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival. Methods: A single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients’ baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low (<10 %) LSF. Baseline comparisons were performed using Fisher’s exact tests for categorical and Mann–Whitney U test for continuous variables. Survival was calculated using the Kaplan–Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed. Results: There was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 %CI 12.73–55.23), with 4.77 months (95 %CI 2.87–26.73) for high and 42.77 months (95 %CI 18.47–59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival. Conclusions: LSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.

KW - Hepatopulmonary Shunt Fraction

KW - Liver Metastases

KW - Neuroendocrine Tumors

KW - Survival Biomarker

KW - Yttrium-90 Radioembolization

UR - http://www.scopus.com/inward/record.url?scp=84960385266&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960385266&partnerID=8YFLogxK

U2 - 10.1007/s00270-016-1323-4

DO - 10.1007/s00270-016-1323-4

M3 - Article

VL - 39

SP - 1007

EP - 1014

JO - CardioVascular and Interventional Radiology

JF - CardioVascular and Interventional Radiology

SN - 7415-5101

IS - 7

ER -