Y-90: Prognosis Predictors for Patients with Liver Metastases from Colorectal Cancer

Analysis of several pretreatment factors may help predict the prognosis of patients treated with ytrrium-90 (Y-90) radioembolization for liver metastases from colorectal cancer.

Prediction of outcomes after radioembolization has been difficult, with previous studies identifying various factors. The researchers undertook the current study to further investigate which factors may predict a favorable or poor prognosis.

“Optimal selection of patients with colorectoral cancer liver metastases may improve survival rates after administration of yttrium-90,” the researchers wrote.

The study included 131 patients who underwent radioembolization for liver metastases from colorectal cancer. The treatments took place at 2 academic medical centers from 2007 to 2014, and 21 baseline pretreatment factors were evaluated in association with overall survival.

Results indicated a median overall survival of 10.7 months after the first radioembolization procedure. There were several pretreatment factors identified that were linked with significant improvement in overall survival after radioembolization. These factors were lower carcinoembryonic antigen, lower aspartate transaminase (AST), neutrophil-lymphocyte ratio (NLR) <5, and absence of extrahepatic disease at baseline. Multivariate analysis revealed that higher carcinoembryonic antigen, higher AST, NLR ≥5, extrahepatic disease, and larger volume of liver metastases remained independently associated with risk of death.

“In summary, markers of tumor (CEA), liver function (AST), and inflammation (NLR) as well as degree of tumor burden (both hepatic and extrahepatic disease) are independent predictors for OS in patients with metastatic CRC treated with RE in the chemorefractory setting,” the authors stated. They added, “Particularly given the negative data for PFS and OS with RE in the first-line setting in the SIRFLOX and combined SIRFLOX, FOXFIRE, and FOXFIRE Global studies, selection of patients for RE is paramount.” The study’s authors recommended that future research evaluate prognostic factors in larger patient cohorts.

Reference

Weiner AA, Gui B, Newman NB, Nosher JL, et al. Predictors of survival after yttrium-90 radioembolization for colorectal cancer liver metastases. J Vasc Interv Radiol. 2018 May 10. pii: S1051-0443(18)30960-6. doi: 10.1016/j.jvir.2018.02.020. [Epub ahead of print].