Elevated Alkaline Phosphatase Prior to Transarterial Chemoembolization for Neuroendocrine Tumors Predicts Worse Outcomes.
BACKGROUND
We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases.


METHODS
We reviewed all patients who underwent TACE for metastatic NET between 2009 and 2013. Survival was evaluated using preprocedure variables.


RESULTS
One hundred and nine patients underwent 210 TACE procedures. The average age was 57.7 years (range 20-78). Primary sites included pancreas (N = 20), other gastrointestinal (N = 52), lung (N = 9), and unknown (N = 28). The tumor was grade 1 in 68 (62 %), grade 2 in 21 (19 %), and grade 3 in 3 (3 %). Extrahepatic disease was present in 54 (50 %) and greater than 50 % hepatic tumor burden by imaging in 63 (58 %). Elevated bilirubin occurred in 8 (7 %), elevated AP in 22 (20 %), elevated ALT in 21 (19 %), and elevated AST in 41 (38 %). Univariate predictors included tumor grade (43 vs 27 vs 21 months, p = 0.015), hepatic tumor burden (59 vs 37 months, p = 0.009), and elevated AP (59 vs 23 months, p < 0.001). On multivariate analysis, only elevated AP (p = 0.001) predicted worse survival.


CONCLUSIONS
Elevated AP prior to TACE for metastatic NET portends a worse survival outcome, even more so than tumor grade or extent of hepatic disease.
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA. JillOnesti@gmail.com.
Jill K
JK
Onesti
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Lawrence A
LA
Shirley
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Neil D
ND
Saunders
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Gail W
GW
Davidson
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Mary E
ME
Dillhoff
Division of Interventional Radiology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Hooman
H
Khabiri
Division of Interventional Radiology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Gregory E
GE
Guy
Division of Interventional Radiology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Joshua D
JD
Dowell
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Carl R
CR
Schmidt
Division of Medical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Manisha H
MH
Shah
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 250 Cherry St, Grand Rapids, MI, 49503, USA.
Mark
M
Bloomston
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000378:metabolism*; D016461:Chemoembolization, Therapeutic; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000201:enzymology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000201:enzymology / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018358:Neuroendocrine Tumors / Q000201:enzymology* / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
D000469:Alkaline Phosphatase
Metastatic neuroendocrine; Outcomes; Predict; Transarterial chemoembolization