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Nomogram including pretherapeutic parameters for prediction of survival after SIRT of hepatic metastases from colorectal cancer

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Pre-therapeutic prediction of outcome is important for clinicians and patients in determining whether selective internal radiation therapy (SIRT) is indicated for hepatic metastases of colorectal cancer (CRC).

Methods

Pre-therapeutic characteristics of 100 patients with colorectal liver metastases (CRLM) treated by radioembolization were analyzed to develop a nomogram for predicting survival. Prognostic factors were selected by univariate Cox regression analysis and subsequent tested by multivariate analysis for predicting patient survival. The nomogram was validated with reference to an external patient cohort (n = 25) from the Bonn University Department of Nuclear Medicine.

Results

Of the 13 parameters tested, four were independently associated with reduced patient survival in multivariate analysis. These parameters included no liver surgery before SIRT (HR:1.81, p = 0.014), CEA serum level ≥ 150 ng/ml (HR:2.08, p = 0.001), transaminase toxicity level ≥2.5× upper limit of normal (HR:2.82, p = 0.001), and summed computed tomography (CT) size of the largest two liver lesions ≥10 cm (HR:2.31, p < 0.001). The area under the receiver-operating characteristic curve for our prediction model was 0.83 for the external patient cohort, indicating superior performance of our multivariate model compared to a model ignoring covariates.

Conclusions

The nomogram developed in our study entailing four pre-therapeutic parameters gives good prediction of patient survival post SIRT.

Key Points

• Four individual parameters predicted reduced survival following SIRT in CRC.

• These parameters were combined into a nomogram of pre-therapeutic risk stratification.

• The model provided good prediction of survival in two independent patient cohorts.

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Acknowledgments

We thank Dr. Alexander Crispin (Institute of Medical Informatics, Biometry, and Epidemiology, Munich, Germany) for valuable statistical advice. The authors acknowledge professional manuscript revisions by Inglewood Biomedical Editing. The scientific guarantor of this publication is Wolfgang Peter Fendler, MD. The authors of this manuscript declare relationships with the following companies: A.H., T.J., P.B., and S.E. have received fees or travel-related expense reimbursement for oral presentations at events organized by SIRTeX Medical (Sydney, Australia). P.P. and T.J. have an advisory relationship with SIRTeX Medical. The other authors declare that they have no potential conflicts of interest. The authors state that this work has not received any funding. One of the contributors, Dr. Alexander Crispin (Institute of Medical Informatics, Biometry, and Epidemiology, Munich, Germany), has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Some study subjects or cohorts have been previously reported in: Fendler WP, Philippe Tiega DB, Ilhan H, et al. Validation of Several SUV-Based Parameters Derived from 18F-FDG PET for Prediction of Survival after SIRT of Hepatic Metastases from Colorectal Cancer. J Nucl Med. 2013;54:1202–1208. Methodology: retrospective, diagnostic or prognostic multi-centre study.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany

    Wolfgang Peter Fendler, Harun Ilhan, Peter Bartenstein & Alexander R. Haug

  2. Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany

    Philipp M. Paprottka

  3. Department of Diagnostic and Interventional Radiology, Hospital Barmherzige Brueder, Munich, Germany

    Tobias F. Jakobs

  4. Department of Internal Medicine III, Ludwig-Maximilians-University of Munich, Munich, Germany

    Volker Heinemann

  5. Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany

    Volker Heinemann, Peter Bartenstein & Alexander R. Haug

  6. Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany

    Feras Khalaf

  7. Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany

    Samer Ezziddin

  8. Department of Nuclear Medicine, Vienna General Hospital, Vienna, Austria

    Marcus Hacker

  9. Klinik und Poliklinik für Nuklearmedizin, Marchioninistrasse 15, 81377, Munich, Germany

    Wolfgang Peter Fendler

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  1. Wolfgang Peter Fendler
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Corresponding author

Correspondence to Wolfgang Peter Fendler.

Electronic supplementary material

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Supplemental Fig. S1

Diagram showing the flow of patients through the study (JPEG 1280 kb)

Supplemental Fig. S2

Underlying statistic model for building the nomogram. The probability of 1-year survival is calculated as follows: Probability of 1-year survival = EXP(-CBH*EXP(a*total points)); CBH = 0.215; EXP = Exponential function; CBH = Cumulative baseline hazard (JPEG 168 kb)

Supplemental Fig. S3

Receiver-operating-characteristic curves of the prediction model versus a model that ignores covariates for (A) internal and (B) external validation (JPEG 603 kb)

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Fendler, W.P., Ilhan, H., Paprottka, P.M. et al. Nomogram including pretherapeutic parameters for prediction of survival after SIRT of hepatic metastases from colorectal cancer. Eur Radiol 25, 2693–2700 (2015). https://doi.org/10.1007/s00330-015-3658-7

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  • DOI: https://doi.org/10.1007/s00330-015-3658-7

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