Hormonal tumor mapping for liver metastases of gastroenteropancreatic neuroendocrine neoplasms: a novel therapeutic strategy.
Hormonal tumor mapping for liver metastases of gastroenteropancreatic neuroendocrine neoplasms: a novel therapeutic strategy.
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胃肠胰神经内分泌肿瘤肝转移的激素肿瘤图谱：一种新的治疗策略。
DOI：
10.1007/s00432-021-03650-2
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Tanabe M.
中科院分区：
文献类型：
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作者：
Maekawa A;Kudo A;Kishino Mitsuhiro;Murase Y;Watanabe S;Ishikawa Y;Ueda Hiroki;Akahoshi K;Ogawa K;Ono H;Tanaka S;Kinowaki Y;Tanabe M.
目的转移性功能性胃肠胰腺神经内分泌肿瘤（GEP NEN）患者，目前尚不清楚需要多大程度的肿瘤缩小才能消除激素症状。我们的目的是通过有效的最小干预来减少晚期GEP-NEN的激素症状，构建肝转移瘤的激素肿瘤地图。通过经肝动脉注射葡萄糖酸钙并监测三条肝静脉中血清激素浓度的变化来识别含有产瘤肝段。激素浓度的两倍以上的增加表明肿瘤feeding vessel.ResultsCases包括8个胰岛素瘤和4个胃泌素瘤。3例患者的原发性病变为功能性病变，9例为非功能性病变。9例患者显示激素升高，表明存在功能性病变; 8例显示肿瘤肝段升高，而1例同步肝转移仅在胰腺区升高。5名患者接受了手术。3例患者在切除罪犯病灶后血清激素浓度显著降低;所有患者的激素症状均立即改善。3例既往接受过手术治疗的患者表现出升高，接受了经导管动脉栓塞术，激素症状得到暂时改善。四名患者表现出不明确的本地化生产的肿瘤，治疗方案是有限的，导致在穷人outcomes.ConclusionHormonal肿瘤映射表现出异质性激素生产之间的原发性和转移性肿瘤的GEP-NEN。基于激素定位的微创治疗可能是传统细胞减灭术的可行替代方案。
PurposeIn patients with metastatic functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), it is unknown what degree of tumor reduction is required to eliminate hormonal symptoms. We aimed to reduce hormonal symptoms derived from advanced GEP-NENs by efficient minimal intervention, constructing a hormonal tumor map of liver metastases.MethodsBetween 2013 and 2019, we treated 12 insulinoma or gastrinoma patients with liver metastases. Liver segments containing hormone-producing tumors were identified by injecting calcium gluconate via the hepatic arteries and monitoring the change in serum hormone concentration in the three hepatic veins. A greater-than-twofold increase in hormone concentration indicated a tumor-feeding vessel.ResultsCases included eight insulinomas and four gastrinomas. Primary lesions were functional in three patients and nonfunctional in 9. Nine patients showed hormonal step-up indicating the presence of functional lesions; eight showed step-up in tumor-bearing liver segments, while one with synchronous liver metastases showed step-up only in the pancreatic region. Five patients underwent surgery. Serum hormone concentration decreased markedly after removing the culprit lesions in 3; immediate improvement in hormonal symptoms was achieved in all patients. Three patients with previous surgical treatment who showed step-up underwent transcatheter arterial embolization, achieving temporary improvement of hormonal symptoms. Four patients showed unclear localization of the hormone-producing tumors; treatment options were limited, resulting in poor outcomes.ConclusionHormonal tumor mapping demonstrated heterogeneity in hormone production among primary and metastatic tumors of GEP-NENs. Minimally invasive treatment based on hormonal mapping may be a viable alternative to conventional cytoreduction.