Surgical Resection Improves the Outcome of the Patients With Neuroendocrine Tumor Liver Metastases

Abstract

How to properly manage neuroendocrine liver metastasis (NELM) remains debatable, and only limited clinical data have been published from Asian population. The objective of this study is to identify possible prognostic factors affecting overall survival time and to provide a guideline for future clinical practice.A retrospective study was performed on 1286 patients who had neuroendocrine tumors in our specialized center, and data from 130 patients who had NELM were summarized. Demographic and clinicopathologic data, tumor grade, treatment method, and prognosis were statistically analyzed.Most of the NELMs originated from pancreas (65.4%). Important prognostic factors that included tumor location and size were identified with multivariate analysis. Patients with either primary tumor resection or liver metastasis resection showed a 5-year survival of 35.7% or 33.3%, respectively, whereas resection of both resulted in a 50% 5-year survival. More importantly, resection was performed on 7 patients with grade 3 (G3) tumors, and resulted in 1-year, 3-year, and 5-year survival of 100%, 42.8%, and 28.6%, respectively, whereas the other 9 G3 patients without resection died within 3 years. P = 0.49 comparing the resected group with nonresected group in G3 patients. Besides, the overall 5-year survival rates for resected and nonresected patients were 40.5% and 5.4%, respectively.Multiple prognostic factors influenced the overall outcome of NELM including patient age, tumor location, and size, etc. Aggressive surgical approaches could be considered for maximum survival time disregarding the pathological grade of the tumor. Study with larger sample size should be considered to reevaluate the recommendation of the WHO guidelines for G3 neuroendocrine tumors.

Resection of the primary tumor improves survival in patients with gastro‐entero‐pancreatic neuroendocrine neoplasms with liver metastases: A SEER‐based analysis

“…To achieve curative intent, the complete removal of primary and metastatic tumors should be considered. Earlier studies have found that PTR improved the 5‐year OS rates of patients, ranging from 33.3% to 74.0%, irrespective of tumor function . Consistent with these results, compared to the nonresection group, an improvement in 5‐year OS rates (from 15.4% to 57.0%) was observed in our study.…”

“…Recently, a retrospective study by Tierney et al showed significantly prolonged survival of patients with metastatic disease who underwent PTR . Nevertheless, this study did not make a distinction between LM and other sites of metastases, and several studies that support PTR were limited by their small sample size and the analysis of a single primary site …”

Multimodal Therapy for Pancreatic Neuroendocrine Tumors with Multiple Liver Metastases - Two Case Reports

“…Liver metastases accounts for about 90% of the distant metastases of PNET and is a major prognostic factor for this tumor [2,10,11]. Previous researchers have reoprted that the concurrent resection of both the primary lesion and resectable liver metastases is feasible and might improve the prognosis [3][4][5][6].…”

Pancreatic neuroendocrine tumors

“…This characteristic is associated with the overexpression of both ligand and related receptor of vascular endothelial factor (VEGF) (63), particularly in hepatic metastases (64). Sunitinib is an oral, smallmolecule, multi-targeted tyrosine kinase inhibitor with activity against VEG-F and PDGF.…”