Hepatopulmonary shunting: A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization

Kazim H. Narsinh, Mark Van Buskirk, Andrew S. Kennedy, Mohammed Suhail, Naif Alsaikhan, Carl K. Hoh, Kenneth Thurston, Jeet Minocha, David S. Ball, Steven J. Cohen, Michael Cohn, Douglas M. Coldwell, Alain Drooz, Eduardo Ehrenwald, Samir Kanani, Charles W. Nutting, Fred M. Moeslein, Michael A. Savin, Sabine Schirm, Samuel G. PutnamNavesh K. Sharma, Eric A. Wang, Steven C. Rose

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Abstract

Purpose: To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods: Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results: LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion: Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases.

Original languageEnglish (US)
Pages (from-to)281-288
Number of pages8
JournalRadiology
Volume282
Issue number1
DOIs
StatePublished - Jan 2017

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Adenocarcinoma
Lung
Survival
Liver
Carcinoembryonic Antigen
Neoplasm Metastasis
Yttrium
Research Ethics Committees
Tumor Biomarkers
Serum
Proportional Hazards Models
Colorectal Neoplasms
Neoplasms
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Narsinh, K. H., Van Buskirk, M., Kennedy, A. S., Suhail, M., Alsaikhan, N., Hoh, C. K., ... Rose, S. C. (2017). Hepatopulmonary shunting: A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization. Radiology, 282(1), 281-288. https://doi.org/10.1148/radiol.2016152100
Narsinh, Kazim H. ; Van Buskirk, Mark ; Kennedy, Andrew S. ; Suhail, Mohammed ; Alsaikhan, Naif ; Hoh, Carl K. ; Thurston, Kenneth ; Minocha, Jeet ; Ball, David S. ; Cohen, Steven J. ; Cohn, Michael ; Coldwell, Douglas M. ; Drooz, Alain ; Ehrenwald, Eduardo ; Kanani, Samir ; Nutting, Charles W. ; Moeslein, Fred M. ; Savin, Michael A. ; Schirm, Sabine ; Putnam, Samuel G. ; Sharma, Navesh K. ; Wang, Eric A. ; Rose, Steven C. / Hepatopulmonary shunting : A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization. In: Radiology. 2017 ; Vol. 282, No. 1. pp. 281-288.
@article{3a3e7530a48c43ee96f47c83df9f4bc2,
title = "Hepatopulmonary shunting: A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization",
abstract = "Purpose: To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods: Retrospective data were analyzed from 606 patients (62{\%} men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results: LSF higher than 10{\%} was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5{\%} to more than 20{\%} (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion: Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases.",
author = "Narsinh, {Kazim H.} and {Van Buskirk}, Mark and Kennedy, {Andrew S.} and Mohammed Suhail and Naif Alsaikhan and Hoh, {Carl K.} and Kenneth Thurston and Jeet Minocha and Ball, {David S.} and Cohen, {Steven J.} and Michael Cohn and Coldwell, {Douglas M.} and Alain Drooz and Eduardo Ehrenwald and Samir Kanani and Nutting, {Charles W.} and Moeslein, {Fred M.} and Savin, {Michael A.} and Sabine Schirm and Putnam, {Samuel G.} and Sharma, {Navesh K.} and Wang, {Eric A.} and Rose, {Steven C.}",
year = "2017",
month = "1",
doi = "10.1148/radiol.2016152100",
language = "English (US)",
volume = "282",
pages = "281--288",
journal = "Radiology",
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Narsinh, KH, Van Buskirk, M, Kennedy, AS, Suhail, M, Alsaikhan, N, Hoh, CK, Thurston, K, Minocha, J, Ball, DS, Cohen, SJ, Cohn, M, Coldwell, DM, Drooz, A, Ehrenwald, E, Kanani, S, Nutting, CW, Moeslein, FM, Savin, MA, Schirm, S, Putnam, SG, Sharma, NK, Wang, EA & Rose, SC 2017, 'Hepatopulmonary shunting: A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization', Radiology, vol. 282, no. 1, pp. 281-288. https://doi.org/10.1148/radiol.2016152100

Hepatopulmonary shunting : A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization. / Narsinh, Kazim H.; Van Buskirk, Mark; Kennedy, Andrew S.; Suhail, Mohammed; Alsaikhan, Naif; Hoh, Carl K.; Thurston, Kenneth; Minocha, Jeet; Ball, David S.; Cohen, Steven J.; Cohn, Michael; Coldwell, Douglas M.; Drooz, Alain; Ehrenwald, Eduardo; Kanani, Samir; Nutting, Charles W.; Moeslein, Fred M.; Savin, Michael A.; Schirm, Sabine; Putnam, Samuel G.; Sharma, Navesh K.; Wang, Eric A.; Rose, Steven C.

In: Radiology, Vol. 282, No. 1, 01.2017, p. 281-288.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hepatopulmonary shunting

T2 - A prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with 90Y radioembolization

AU - Narsinh, Kazim H.

AU - Van Buskirk, Mark

AU - Kennedy, Andrew S.

AU - Suhail, Mohammed

AU - Alsaikhan, Naif

AU - Hoh, Carl K.

AU - Thurston, Kenneth

AU - Minocha, Jeet

AU - Ball, David S.

AU - Cohen, Steven J.

AU - Cohn, Michael

AU - Coldwell, Douglas M.

AU - Drooz, Alain

AU - Ehrenwald, Eduardo

AU - Kanani, Samir

AU - Nutting, Charles W.

AU - Moeslein, Fred M.

AU - Savin, Michael A.

AU - Schirm, Sabine

AU - Putnam, Samuel G.

AU - Sharma, Navesh K.

AU - Wang, Eric A.

AU - Rose, Steven C.

PY - 2017/1

Y1 - 2017/1

N2 - Purpose: To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods: Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results: LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion: Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases.

AB - Purpose: To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods: Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results: LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion: Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases.

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U2 - 10.1148/radiol.2016152100

DO - 10.1148/radiol.2016152100

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JO - Radiology

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