Treatment Patterns and Prognostic Nomograms for Overall Survival and Hepatic Progression-Free Survival in Unresectable Colorectal Liver Metastases Treated with Drug-Eluting Bead Chemoembolization: A Single-Center Study

Vollständiger Abstract

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(1) Background: Drug-eluting bead transarterial chemoembolization (DEB-TACE) is increasingly used for unresectable colorectal liver metastases (CRLM), yet individualized prognostic tools are lacking. We developed and internally validated nomograms predicting overall survival (OS) and hepatic progression-free survival (hPFS). (2) Methods: In this single-center retrospective cohort, reported per the TRIPOD guideline, OS and hPFS were estimated by Kaplan–Meier methods, and independent predictors from multivariable Cox regression were assembled into nomograms. Internal validation combined 1000-sample bootstrap optimism-corrected concordance indices (C-index), a uniform shrinkage factor, a bootstrap calibration slope, and a LASSO–Cox sensitivity analysis. (3) Results: Among 63 patients (44 deaths; 42 intrahepatic-progression events), median OS was 10.9 months and median hPFS was 5.8 months. Independent OS predictors were baseline CEA, high liver tumor burden (≥10 lesions), CEA decline (protective), and second-line-or-beyond interventional therapy (corrected C-index: 0.796). Independent hPFS predictors were high liver tumor burden, CEA decline, and age (corrected C-index: 0.718). Nomogram-defined high-risk groups had markedly shorter OS (5.3 vs. 22.8 months) and hPFS (3.3 vs. 8.6 months; both p < 0.001). Grade ≥3 toxicity occurred in 6%. (4) Conclusions: In real-world DEB-TACE-treated CRLM, liver tumor burden and CEA dynamics dominated prognosis; the internally validated nomograms provide individualized estimates and risk stratification, pending external validation.