The Role of Primary Tumor Resection in Patients With Pancreatic Neuroendocrine Tumors With Liver Metastases

Abstract

BackgroundLiver metastases (LMs) are common in advanced pancreatic neuroendocrine tumor (PNET) patients. Currently, the benefit of primary tumor resection (PTR) in the setting of PNET patients with liver metastases is still controversial in several guidelines.MethodsData were extracted from the Surveillance, Epidemiology and End Results (SEER) database to evaluate this issue. The main index of interest in our study was overall survival time.ResultsInformation on 536 PNET patients with liver metastases from the SEER database was identified. A total of 214 patients (PTR group) received primary tumor resection, and more than half of them (132 patients) had synchronous LM resection. The other 322 PNET patients (non-PTR group) with liver metastases did not receive primary tumor resection. A significant survival benefit was gained from PTR when compared with non-PTR patients, both in OS (72.93 ± 2.7 vs. 36.80 ± 2.22 months) and 3- or 5-year survival rates (75.1% vs. 28.9% and 67.9% vs. 22.3%, respectively). No difference was found between PTR alone and PTR with synchronous LM resection. From univariate and multivariate analyses, younger age (<65 years) and good or moderate tumor differentiation may be more important when considering primary tumor resection. However, we found that all grades of tumor differentiation could result in a better overall survival time after primary tumor resection.ConclusionOur study suggested that primary tumor resection in pancreatic neuroendocrine patients with liver metastases could result in a longer survival time. Primary tumor resection with synchronous liver metastasis resection was not related to a better survival benefit. This treatment strategy may routinely be taken into consideration in these patients.

Surgical Management of Pancreatic Neuroendocrine Tumors

“…In one study of patients with stage IV PNET, five-year overall survival has been shown to be improved to 56.6% compared to 23.9% for patients managed non-operatively [ 115 ]. These results were similar to a recent study using the surveillance, epidemiology, and end (SEER) database, which found that primary resection in patients with metastatic PNETs to the liver had improved overall survival at 5 years to 67.9% compared to 22.3% for patients who did not undergo resection [ 117 ]. The benefit of resection of the primary tumor and liver metastases is demonstrated even for more extensive pancreatic surgery such as pancreaticoduodenectomy with metastasectomy [ 118 ].…”

“…The most common anatomic location of metastasis from PNET is the liver. Palliative resection may be indicated to alleviate functional syndromes secondary to the hormone secretion, symptoms due to mass effect, or even for survival benefit [ 115 , 116 , 117 , 118 , 119 , 120 ]. In one study of patients with stage IV PNET, five-year overall survival has been shown to be improved to 56.6% compared to 23.9% for patients managed non-operatively [ 115 ].…”

Graph Attention Networks for Drug Combination Discovery: Targeting Pancreatic Cancer Genes with RAIN Protocol

“…In summary, effective management of pancreatic malignant neoplasm plays a vital role in improving patient survival, reducing recurrence, and enhancing overall quality of life. [4], [5], [6]…”

“…In summary, effective management of pancreatic malignant neoplasm plays a vital role in improving patient survival, reducing recurrence, and enhancing overall quality of life. [4], [5], [6] 1.1. Associated human genes/Proteins Mutations in the KRAS gene are some of the most common genetic changes.…”

Two machine learning-based nomogram to predict risk and prognostic factors for liver metastasis from pancreatic neuroendocrine tumors: a multicenter study

“…The ability to accurately predict the survival of patients with hepatic metastasis from PNETs will enable doctors to better conduct clinical management. The prognostic factors for overall survival (OS) in PNET patients with hepatic metastasis are controversial [ 7 , 8 ]. Our aim is to investigate the prognostic factors for OS in PNET patients with hepatic metastasis and the risk factors for hepatic metastasis from PNETs and to construct a clinically important nomogram.…”