Predictive impact of the inflammation-based indices in uveal melanoma liver metastases treated with transarterial hepatic chemoperfusion Cover

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Predictive impact of the inflammation-based indices in uveal melanoma liver metastases treated with transarterial hepatic chemoperfusion

Radiology and Oncology

Volume 55 (2021): Issue 3 (September 2021)

By: Johannes M. Ludwig, Johannes Haubold, Sebastian Bauer, Heike Richly, Jens T. Siveke, Julia Wimmer, Lale Umutlu, Benedikt M. Schaarschmidt and Jens M. Theysohn

Open Access

|May 2021

Figures & Tables

Overall survival of the entire study cohort. Estimated overall survival (OS) after diagnosis of primary, diagnosis of liver metastases, and after 1st transarterial chemoperfusion (THC).

Pretreatment inflammation-based markers predict overall survival. Overall survival is stratified for low (≦ median) vs. high (> median) neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP).

Scoring further improves overall survival estimation. Patients with zero to one elevated independent significant factors from multivariate analysis (C-reactive protein [CRP], systemic immune-inflammation index [SII], alanine aminotransferases [ALT]) had a significantly longer overall survival than patients with two or three elevated factors p < 0.0001.

Uni- and multivariate analysis of overall survival (OS)

		Median (95OS % in CI) months	Univariate analysis		Multivariate analysis
Subgroups			HR (95% CI)	p-value	HR (95% CI)	p-value
NLR	≦ median (3.58) > median (3.58)	11.1 (7.1–20.6) 6.3 (3.5–7.8)	0.39 (0.2–0.75) 1	0.0045	0.73 (0.25–2.2) 1	0.57
SII	≦ median (1076) > median (1076)	10.8 (7,2–20.6) 5.6 (3.4 – 7.7)	0.33 (0.17 – 0.65) 1	0.0013	0.19 (0.11–0.7) 1	0.008
PLR	≦ median (203.8) > median (203.8)	8.2 (5.6–15.8) 7.5 (4.7–11.1)	0.69 (0.37–1.27) 1	0.23	- -	-
CRP	normal > ULN	13.5 (7.2–20.6) 5.3 (3.9–7.8)	0.3 (0.15–0.6) 1	0.0005	0.29 (0.11–0.7) 1	0.005
Neutrophils	normal > ULN	8.2 (6.4–11.5) 6.3 (3.9–11.1)	0.6 (0.3–1.28) 1	0.18	- -	-
Thrombocytes	normal > ULN	8.2 (63–11.1) 7.5 (0.64–13.5)	0.8 (0.35–2.13) 1	0.62	- -
LDH	≦ ULN >ULN	12.8 (7.2–20.6) 7 (4.8–8.2)	0.54 (0.23–1.11) 1	0.1	- -	-
AST	≦ ULN > ULN	11.5 (7.2–20.6) 5.6 (4.5–8.2)	0.45 (0.22–0.85) 1	0.015	0.34 (0.07–1.44) 1	0.15
ALT	≦ ULN > ULN	11.5 (7.5–15.8) 5.6 (4.2–7.8)	0.43 (0.2–0.8) 1	0.01	0.13 (0.02–0.63) 1	0.011
GGT	≦ ULN > ULN	10.9 (7.2–15.8) 7.13 (5.3–10.2)	0.94 (0.32–2.2) 1	0.9	- -	-
AP	≦ ULN > ULN	10.94 (4.8–20.6) 6.3 (3.4–10.1)	0.54 (0.22–1.26) 1	0.15	– -	-
Hepatic tumor burden	50% ≦ > 50%	8.2 (7.12–11.5) 4.8 (1.2–7.8)	0.36 (0.18–0.74) 1	0.007	0.5 (0.17–1.6) 1	0.24
Prior systemic treatment	Yes No	8.2 (7.5–11.5) 6.3 (4.5–11.1)	0.78 (0.42–1.45) 1	0.43	- -	-
Extrahepatic metastases	No Yes	7.12 (4.6–10.1) 10.2 (6.3–11.1)	1.1 (0.59–2.17) 1	0.75	- -	-

Overview of patient baseline characteristics

Characteristics	Number of patients (%) / median values
Total number of patients	54
Gender (male).	24 (44%)
Median age in years at 1^st THC (range)	61 (26–81)
Prior systemic/liver-directed therapies
Prior systemic therapy	29 (53.7%)
Sorafenib	25 (46.3)
MEK and PKC inhibitors	3 (5.6%)
Ipilimumab	1 (1.9%)
Conventional chemotherapy	5 (9%)
Prior liver resection	4 (7.4%)
Prior ablation	1 (1.9%)
Further therapy after last transarterial chemoperfusion	18 (33.3%)
Limited extrahepatic metastases at the time of 1^st THC	20 (37%)
Median maximal tumor size in cm (range)	5.9 (1.3–19.8)
Lobar tumor involvement
Bilobar	54 (96.4%)
Unilobar	2 (3.6%)
Hepatic tumor burden
0–25%	23 (46%)
> 25–50%	12 (24%)
> 50–75%	9 (18%)
> 75%	6 (12%)
ECOG
0	43 (80%)
1	6 (11%)
2	2 (4%)
Unknown	3 (6%)
Karnofsky Index
100	4 (7%)
90	33(61%)
80	7 (13%)
< 80	3 (6%)
Unknown	7 (13%)

Scoring with significant independent factors from multivariate analysis_ The number of elevated CRP, SII, ALT in patients further helps to predict median overall survival

Group	Median OS in months (95% CI)	Hazard ratio (95% CI)	p-value
≦ 1 elevated factor	14.9 (10.1–0.0)	0.08 (0.3–0.2)	-
2 elevated factors	6.7 (4.5–8.2)	0.38 (0.17–0.86)	0.0003
3 elevated factors	3.9 (1.15–6.3)	1	< 0.0001*

DOI: https://doi.org/10.2478/raon-2021-0027 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 347 - 353

Submitted on: Jan 17, 2021

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Accepted on: Apr 12, 2021

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Published on: May 31, 2021

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

uveal melanoma,

liver metastases,

transarterial hepatic chemoperfusion,

inflammatory markers

Related subjects:

Clinical medicine,

Internal medicine,

Haematology, oncology,

© 2021 Johannes M. Ludwig, Johannes Haubold, Sebastian Bauer, Heike Richly, Jens T. Siveke, Julia Wimmer, Lale Umutlu, Benedikt M. Schaarschmidt, Jens M. Theysohn, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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