Predictive impact of the inflammation‐based indices in uveal melanoma liver metastases treated with transarterial hepatic chemoperfusion
Chemoperfusion for Uveal melanoma Liver metastases therapy
Purpose: To evaluate pretreatment inflammatory markers as prognostic factors in patients with unresectable uveal melanoma liver metastases treated with transarterial hepatic chemoperfusion.
Materials and Methods: 54 patients (44% male, median age: 61 years) were retrospectively assessed. A median of 3 (range: 1-11) treatment sessions were performed with melphalan (92%) or Fotemustin (8%). Inflammatory indices were calculated as follows: NLR: (neutrophils/nl)/(lymphocytes/nl), SII: (platelets/nl × neutrophils/nl)/(lymphocytes/nl), and PLR: (platelets/nl)/(lymphocytes/nl).
The cut-off for dichotomization purposes was set at the median (inflammatory indices, hepatic tumor burden) or the upper level of normal. Kaplan Meier analysis was performed for median overall survival (OS) in months, and Cox Proportional Hazard Model for uni- (UVA) & multivariate (MVA) hazard ratio (HR, 95%CI) analyses were performed.
Results: Median OS of the study cohort was 7.7 (6.3-10.9) months. In UVA OS was prolonged for low CRP (13.5 vs. 5.2;p=.0005), low SII (10.8 vs. 5.6;p=.0005), low NLR (11.1 vs. 6.3; p=.0045), low AST (11.5 vs. 5.6;p=.015), ALT (11.5 vs. 5.6;p=.01), and tumor burden ≦50% (8.2 vs. 4.8, p=.007). MVA confirmed low CRP (HR: 0.29, 0.11-0.7;p=.005), low SII (HR: 0.19, 0.11-0.7;p=.008), and low ALT (HR: 0.13, 0.02-0.63;p=.011) were confirmed as independent predictors for prolonged OS. Patients with ≦1, 2, 3 elevated significant MVA-factors survived a median of 14.9, 7.7, and 3.9 months, p=.0001.
Conclusion: Pretreatment inflammatory markers (CRP, SII) and AST are independent prognostic survival markers in patients with uveal melanoma liver metastases treated with transarterial hepatic chemoperfusion. A combination of factors may help to identify patients potentially benefitting from treatment.
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