title: Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients.
abstract: OBJECTIVE
  To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE).
  
  
  METHODS
  We retrospectively analyzed the pre-therapeutic characteristics (sex, age, tumor entity, hepatic tumor burden, extrahepatic disease [EHD] and liver function [with focus on bilirubin and cholinesterase level]) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma [HCC], cholangiocarcinoma [CCC], neuroendocrine tumor [NET], colorectal cancer [CRC] and metastatic breast cancer [MBC]), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival.
  
  
  RESULTS
  The median OS was 356 days (95% CI 285-427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (P < 0.001), large tumor burden (P = 0.001), high bilirubin levels (>1.9 mg/dL, P < 0.001) and low cholinesterase levels (CHE <4.62 U/I, P < 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS.
  
  
  CONCLUSIONS
  Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.
authors.affiliation: Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany. karolin.paprottka@med.lmu.de.
authors.forename: K J
authors.initials: KJ
authors.lastname: Paprottka
authors.affiliation: Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schoeppe
authors.affiliation: Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ingrisch
authors.affiliation: Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Rübenthaler
authors.affiliation: Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
authors.forename: N N
authors.initials: NN
authors.lastname: Sommer
authors.affiliation: Department of Hepatology, LMU - University of Munich, Munich, Germany.
authors.forename: E
authors.initials: E
authors.lastname: De Toni
authors.affiliation: Department of Nuclear Medicine, LMU - University of Munich, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Ilhan
authors.affiliation: Department of Nuclear Medicine, LMU - University of Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Zacherl
authors.affiliation: Department of Nuclear Medicine, LMU - University of Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Todica
authors.affiliation: Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
authors.forename: P M
authors.initials: PM
authors.lastname: Paprottka
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D015021:Yttrium Radioisotopes
keywords: Prediction; Radioembolization; Survival