title: Factors affecting periprocedural morbidity and mortality and long-term patient survival after arterial embolization of hepatic neuroendocrine metastases.
abstract: OBJECTIVE
  To identify factors affecting periprocedural morbidity and mortality and long-term survival following hepatic artery embolization (HAE) of hepatic neuroendocrine tumor (NET) metastases.
  
  
  METHODS
  This single-center, institutional review board-approved retrospective review included 320 consecutive HAEs for NET metastases performed in 137 patients between September 1996 and September 2007. Forty-seven HAEs (15%) were performed urgently to manage refractory symptoms in inpatients (urgent group), and 273 HAEs (85%) were elective (elective group). Overall survival (OS) was estimated by Kaplan-Meier methodology. Complications were categorized per Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to determine independent predictors for OS, complications, and 30-day mortality. The independent factors were combined to develop clinical risk score groups.
  
  
  RESULTS
  Urgent HAE (P = .007), greater than 50% liver replacement by tumor (P < .0001), and extrahepatic metastasis (P = .007) were independent predictors for shorter OS. Patients with all three risk factors had decreased OS versus those with none (median, 8.5 vs 86 mo; P < .001). Thirty-day mortality was significantly lower in the elective (1%) versus the urgent group (8.5%; P = .0009). There were eight complications (3%) in the elective group and five (10.6%) in the urgent group (P = .03). Male sex and urgent group were independent factors for higher 30-day mortality rate (P = .023 and P =.016, respectively) and complications (P = .012 and P =.001, respectively).
  
  
  CONCLUSIONS
  Urgent HAE, replacement of more than 50% of liver by tumor, and extrahepatic metastasis are strong independent predictors of shorter OS. Male sex and urgent HAE carry higher 30-day mortality and periprocedural morbidity risks.
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065. Electronic address: sofoclec@mskcc.org.
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Elena N
authors.initials: EN
authors.lastname: Petre
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Diane
authors.initials: D
authors.lastname: Reidy-Lagunes
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Ivan K
authors.initials: IK
authors.lastname: Ip
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: William
authors.initials: W
authors.lastname: Alago
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Covey
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Brody
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Thornton
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: George I
authors.initials: GI
authors.lastname: Getrajdman
authors.affiliation: Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D009519:New York City; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
keywords: CI; HAE; NET; OS; confidence interval; hepatic artery embolization; neuroendocrine tumor; overall survival