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

Johannes M. Ludwig

Johannes M. Ludwig

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
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Ludwig, Johannes M.
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Johannes Haubold

Johannes Haubold

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
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Haubold, Johannes
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Sebastian Bauer

Sebastian Bauer

Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-EssenEssen, Germany
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Bauer, Sebastian
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Heike Richly

Heike Richly

Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-EssenEssen, Germany
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Richly, Heike
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Jens T. Siveke

Jens T. Siveke

  • Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital EssenEssen, Germany
  • Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZHeidelberg, Germany
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Siveke, Jens T.
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Julia Wimmer

Julia Wimmer

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
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Wimmer, Julia
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Lale Umutlu

Lale Umutlu

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
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Umutlu, Lale
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Benedikt M. Schaarschmidt

Benedikt M. Schaarschmidt

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
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Schaarschmidt, Benedikt M.
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Jens M. Theysohn

Jens M. Theysohn

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-EssenEssen, Germany
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Theysohn, Jens M.
  
31 mag 2021
Predictive impact of the inflammation-based indices in uveal melanoma liver metastases treated with transarterial hepatic chemoperfusion's Cover Image
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Categoria dell'articolo: Research Article
Pubblicato online: 31 mag 2021
Pagine: 347 - 353
Ricevuto: 17 gen 2021
Accettato: 12 apr 2021
DOI: https://doi.org/10.2478/raon-2021-0027
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© 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 Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

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).
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).

Figure 2

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).
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).

Figure 3

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.
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 1st 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 1st 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*
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Medicina, Medicina clinica, Medicina interna, Ematologia, Oncologia, Radiologia
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