91 - Impact of Metabolic Syndrome on Outcomes in Patients with Neuroendocrine Tumor Liver Metastases Treated with Liver Directed Therapy

Purpose: To investigate the impact of metabolic syndrome (MetS) on hepatic progression free survival (HPFS) and overall survival (OS) in patients undergoing transarterial chemoembolization (TACE) or transarterial radioembolization (TARE) for neuroendocrine tumor liver metastases (NETLM).

Materials and Methods: A single-center retrospective chart review investigating patients with NETLM receiving first time liver directed therapy (LDT) from January 2019 to June 2025 was performed. MetS diagnosis at time of LDT was defined using NCEP ATP3 criteria and tumor grade was based on most recent histopathological analysis/KI-67 index. Tumor response was assessed using the RECIST criteria. Patient follow-up ended upon the first occurrence of any of the following: hepatic progression, death, or the last scheduled visit.


Seventy patients receiving first time LDT for NETLM were included, with 60% receiving TACE and 40% receiving TARE. Of the 70 patients, 55.7% had MetS and 92.8% reached the median overall follow-up of 292.5 days. HPFS and OS were calculated using Kaplan-Meier curves and COX regression analysis was performed.

Results: Patients with MetS had an HPFS of 210.5 ± 59.8 versus 320.6 ± 59.9 days without MetS (p = 0.044). Patients with MetS had an OS of 689.4 ± 189.6 versus 1632.6 ± 492.4 days without MetS (p = 0.020). Multivariate analysis for HPFS identified hypertension, female gender, and higher tumor grade (grades 2 and 3) as significant predictors of progression (Table 1). For OS, female gender and higher tumor grade were significant predictors of mortality (Table 1).

When stratified by tumor grade, the negative impact of MetS on OS remained significant in patients with grade 1 and 2 tumors (p = 0.039 and 0.018 respectively). However, this was not observed in patients with grade 3 tumors (N = 12).

There were no significant differences in adverse events between MetS and non-MetS groups.

Conclusion: Patients with MetS receiving LDT had significantly shorter HPFS and OS. These findings highlight the impact of metabolic dysfunction on treatment outcomes and suggest a need for preventative strategies in treating NETLM.