68 - Factors Associated with Overall Survival of Leiomyosarcoma Patients with Metastases to the Liver Undergoing Hepatic Transarterial Embolization

Purpose: Patients with leiomyosarcoma present with diverse features when being considered for locoregional, liver-directed IR therapies. This study evaluated factors influencing overall survival in leiomyosarcoma patients undergoing hepatic transarterial embolization (TAE).

Materials and Methods: After IRB approval, we retrospectively reviewed patients treated between 2010–2024 with leiomyosarcoma and liver metastases who underwent hepatic TAE. Patients who received ablation or other locoregional IR therapies prior to TAE were excluded. Data collected included demographics, tumor number, largest tumor diameter, and liver tumor burden ( < 25%, 25–50%, 50–75%, >75%). Pre-procedure labs (albumin, bilirubin, platelet count) were used to calculate ALBI and pALBI grades. Survival was analyzed using Kaplan-Meier methods, log-rank testing, and Cox proportional hazards modeling. During the preparation of this work, the author(s) used ChatGPT GPT5 in order to improve grammar, spelling, and readability of submission.

Results: Seventy-nine patients were included, with a median follow-up of 12.6 months. The cohort was 75% female, with a mean age of 60 ± 13 years. Bilobar disease was present in 62%, and 81% had extrahepatic disease. Most patients underwent one TAE (53%), while 26% had two and 19% had three or more. The median overall survival of patients with leiomyosarcoma metastatic to the liver who underwent TAE was 17 months. Significant predictors of survival included bilobar disease, extrahepatic disease, number of TAEs, tumor number, largest tumor size, and tumor burden. Patients with < 25% liver tumor burden had significantly longer survival compared with those with greater (25–50%, 50–75%, >75%) tumor burden (31 vs 17 vs 9 vs 4 months, p < 0.001). ALBI and pALBI grade were not significantly associated with survival. On multivariate analysis, unilobar disease (HR 0.39, 95% CI 0.19–0.78, p = 0.008) and a higher number of TAEs (HR 0.64, 95% CI 0.47–0.87, p = 0.004) were positive predictors of survival, while liver tumor burden of 50–75% (HR 6.7, 95% CI 1.3–33, p = 0.008) and >75% (HR 8.4, 95% CI 1.2–60, p = 0.03) were negative predictors.

Conclusion: For leiomyosarcoma patients undergoing hepatic transarterial embolization, pre-procedure liver tumor burden is a strong predictor of overall survival. Tumor burden >50% is associated with the poorest outcomes.