# Inflammation-tumor burden interaction score stratifies survival after irinotecan-eluting bead chemoembolization for colorectal liver metastases

## TL;DR

A new score combining inflammation and tumor burden helps predict survival in patients treated for liver metastases from colorectal cancer.

## Contribution

A novel composite score integrating dynamic inflammation and tumor burden improves survival stratification after chemoembolization.

## Key findings

- Higher ΔCAR and more liver metastases correlate with worse overall survival.
- The CT-IBS score stratifies patients into three distinct survival groups.
- The score shows good predictive accuracy with an area under the curve of 0.703.

## Abstract

Transarterial chemoembolization with irinotecan-loaded drug-eluting beads is an established locoregional option for selected patients with colorectal liver metastases who are not candidates for resection or ablation, but survival outcomes remain heterogeneous and simple prognostic tools are lacking.

In this retrospective single-center study, we analyzed 70 patients treated between 2015 and 2024 to investigate whether the interaction between systemic inflammation and liver tumor burden can stratify survival after this procedure. Dynamic inflammatory change was quantified using the difference in the C-reactive protein-to-albumin ratio (ΔCAR) between baseline and early post-treatment assessments, and liver tumor burden was categorized by the number of metastases (< 5 vs. ≥ 5). These components were integrated into a composite chemoembolization–tumor burden–inflammation balance score (CT-IBS), and its association with early radiologic response, progression-free survival, and overall survival was evaluated using Kaplan–Meier analysis, receiver operating characteristic curves, and multivariable Cox regression.

At a median follow-up of 20.3 months, median progression-free and overall survival were 9.1 and 18.9 months, respectively, and early radiologic response (complete or partial) was observed in 75.7% of patients. Higher ΔCAR and a greater number of liver metastases were independently associated with inferior overall survival. The CT-IBS stratified patients into three distinct prognostic groups (median overall survival 27.3 vs. 17.8 vs. 8.6 months; p < 0.001; area under the curve 0.703).

Integrating dynamic inflammatory changes with liver tumor burden yields a simple, reproducible classification that may support risk stratification, patient selection, and post-treatment surveillance after irinotecan-eluting bead chemoembolization for colorectal liver metastases.