Factors affecting periprocedural morbidity and mortality and long-term patient survival after arterial embolization of hepatic neuroendocrine metastases

J Vasc Interv Radiol. 2014 Jan;25(1):22-30; quiz 31. doi: 10.1016/j.jvir.2013.09.013.

Abstract

Purpose: To identify factors affecting periprocedural morbidity and mortality and long-term survival following hepatic artery embolization (HAE) of hepatic neuroendocrine tumor (NET) metastases.

Materials and 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.

Keywords: CI; HAE; NET; OS; confidence interval; hepatic artery embolization; neuroendocrine tumor; overall survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Embolization, Therapeutic* / adverse effects
  • Embolization, Therapeutic* / mortality
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / mortality
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / therapy*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neuroendocrine Tumors / mortality
  • Neuroendocrine Tumors / secondary*
  • Neuroendocrine Tumors / therapy*
  • New York City
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Survivors*
  • Time Factors
  • Treatment Outcome