Transcatheter arterial embolization in patients with neuroendocrine neoplasms related to liver metastasis with different blood supplies

Abstract

PurposeLiver metastasis is one of the most important factors affecting the prognosis of patients with neuroendocrine neoplasms (NENs). Transhepatic artery embolization (TAE) is the main local treatment of NENs with liver metastasis (NENLM). This study aimed to elucidate the differences between pancreatic and rectal NENLM with a discrepancy in blood supply.MethodsA total of 32 patients with NENLM of different primary sites received 102 TAE treatments at our hospital. Clinical features, such as age, sex, World Health Organization (WHO) tumour grade and progression‐free survival (PFS), were compared between patients with pancreatic and rectal NENLM with different blood supplies. The total follow‐up time is 1–5 years.ResultsThere were 12 cases with tumours originating from the rectum or pancreas, respectively. Other tumour‐originated sites included the duodenum (two cases, 6.25%), the thymus and lung (four cases, 12.5%), and the unknown (two cases, 6.25%). The average age of patients was 51.59 years, and 17 (53.1%) were men. WHO grade 1, 2 or 3 tumours occurred in three (9.4%), 23 (71.9%) and six (18.7%) patients, respectively. Hepatic tumour burdens of low (<25%), middle (25%–50%) and high (>50%) levels were found in 13 (40.6%), eight (25%) and 11 (34.4%) patients, respectively. There were more patients with hypervascular pancreatic NENLM than with hypovascular rectal NENLM (p = 0.005). Tumour shrinkage in all cases with NENLM was 50% with an objective response rate of 37.5%, disease control rate of 75% and PFS of 12 months. Disease progression (p = 0.09), tumour shrinkage (p = 0.07) and death (p = 0.19) were more prominent in the pancreatic NENLM group than in the rectal NENLM group. Progression‐free survival was not reached in the pancreatic NENLM group, which was more prominent than in the rectal NENLM group (7 months; hazard ration, 0.22; 95% confidence interval, 0.07–0.76; p = 0.016). The main adverse events were abdominal pain (71.9%) and transaminase elevation (50%), which were more common in pancreatic NENLM than in rectal NENLM.ConclusionsTranshepatic artery embolization treatment is markedly effective and safe for treating NENLM, especially pancreatic NENLM.

Fasting Blood Glucose-Based Novel Predictors in Predicting Prognosis for Pancreatic Neuroendocrine Neoplasms Patients

“…Interestingly, our results demonstrated the value of FAR for distinguishing synchronous metastasis in pNEN patients. Metastasis seriously affects the prognosis of pNEN patients, [32] and early detection of metastasis could provide important messages for doctors' decision-making in the following practices, which would help improve the treatment outcomes of these patients. However, the mechanism between lower FAR and better prognosis requires further investigation.…”