Elevated Alkaline Phosphatase Prior to Transarterial Chemoembolization for Neuroendocrine Tumors Predicts Worse Outcomes

Introduction We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases. Methods We reviewed all patients who underwent TACE for metastatic NET between...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2016-03, Vol.20 (3), p.580-586
Main Authors: Onesti, Jill K., Shirley, Lawrence A., Saunders, Neil D., Davidson, Gail W., Dillhoff, Mary E., Khabiri, Hooman, Guy, Gregory E., Dowell, Joshua D., Schmidt, Carl R, Shah, Manisha H., Bloomston, Mark
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Alkaline Phosphatase - metabolism
Chemoembolization, Therapeutic
Female
Gastroenterology
Gastrointestinal Neoplasms - enzymology
Gastrointestinal Neoplasms - mortality
Gastrointestinal Neoplasms - pathology
Humans
Liver
Liver Neoplasms - enzymology
Liver Neoplasms - secondary
Liver Neoplasms - therapy
Male
Medicine
Medicine & Public Health
Metastasis
Middle Aged
Multivariate Analysis
Neuroendocrine tumors
Neuroendocrine Tumors - enzymology
Neuroendocrine Tumors - secondary
Neuroendocrine Tumors - therapy
Oncology
Original Article
Phosphatase
Retrospective Studies
Surgery
Treatment Outcome
Tumor Burden
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Summary:Introduction We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases. Methods We reviewed all patients who underwent TACE for metastatic NET between 2009 and 2013. Survival was evaluated using preprocedure variables. Results One hundred and nine patients underwent 210 TACE procedures. The average age was 57.7 years (range 20–78). Primary sites included pancreas ( N  = 20), other gastrointestinal ( N  = 52), lung ( N  = 9), and unknown ( N  = 28). The tumor was grade 1 in 68 (62 %), grade 2 in 21 (19 %), and grade 3 in 3 (3 %). Extrahepatic disease was present in 54 (50 %) and greater than 50 % hepatic tumor burden by imaging in 63 (58 %). Elevated bilirubin occurred in 8 (7 %), elevated AP in 22 (20 %), elevated ALT in 21 (19 %), and elevated AST in 41 (38 %). Univariate predictors included tumor grade (43 vs 27 vs 21 months, p  = 0.015), hepatic tumor burden (59 vs 37 months, p  = 0.009), and elevated AP (59 vs 23 months, p  
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-015-2998-6