Is Long-Term Survival in Metastases from Neuroendocrine Neoplasms Improved by Liver Resection?

• Published in: Medicina (Kaunas, Lithuania) Vol. 58; no. 1; p. 22
• Main Authors: Kraft, Alin, Croitoru, Adina, Moldovan, Cosmin, Lupescu, Ioana, Tomescu, Dana, Purnichescu-Purtan, Raluca, Herlea, Vlad, Popescu, Irinel, Botea, Florin
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 23.12.2021; MDPI
• Subjects: Ablation; Bias; Chemotherapy; Comorbidity; Disease; Embolization; Hepatectomy; Humans; Liver; Liver Neoplasms - surgery; liver resection; Medical prognosis; Metastasis; Mortality; multimodal therapeutic strategy; neuroendocrine neoplasms; Neuroendocrine Tumors - surgery; overall survival; Patients; Peptides; propensity score matching; Radiation therapy; Retrospective Studies; Surgery; Transplants & implants; Tumors; overall survival; liver resection; neuroendocrine neoplasms; multimodal therapeutic strategy; propensity score matching
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina58010022

: Although many of the neuroendocrine neoplasms (NEN) have a typically prolonged natural history compared with other gastrointestinal tract cancers, at least 40% of patients develop liver metastases. This study aims to identify whether liver resection improves the overall survival of patients with liver metastases from NEN. : We conducted a retrospective study at "Fundeni" Clinical Institute over a time period of 15 years; we thereby identified a series of 93 patients treated for NEN with liver metastases, which we further divided into 2 groups as follows: A (45 patients) had been subjected to liver resection complemented by systemic therapies, and B (48 patients) underwent systemic therapy alone. To reduce the patient selection bias we performed at first a propensity score matching. This was followed by a bootstrapping selection with Jackknife error correction, with the purpose of getting a statistically illustrative sample. : The overall survival of the matched virtual cohort under study was 41 months (95% CI 37-45). Group A virtual matched patients showed a higher survival rate (52 mo., 95% CI: 45-59) than B (31 mo., 95% CI: 27-35), ( < 0.001, Log-Rank test). Upon multivariate analysis, seven independent factors were identified to have an influence on survival: location (midgut) and primary tumor grading (G3), absence of concomitant LM, number (2-4), location (unilobar), grading (G3) of LM, and 25-50% hepatic involvement at the time of the metastatic disease diagnosis. : Hepatic resection is nowadays the main treatment providing potential cure and prolonged survival, for patients with NEN when integrated in a multimodal strategy based on systemic therapy.