Metastatic endocrine tumors: Medical treatment, surgical resection, or liver transplantation
Metastatic endocrine tumors: Medical treatment, surgical resection, or liver transplantation
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DOI：
10.1007/s002689900138
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发表时间：
1996-09-01
影响因子：
2.6
通讯作者：
Chapuis, Y
中科院分区：
文献类型：
--
作者：
Dousset, B;SaintMarc, O;Chapuis, Y
我们回顾了31例转移性内分泌肿瘤（MET）患者的经验，这些患者接受了不同的治疗方式。8例患者因病情稳定或手术禁忌症接受化疗或化疗栓塞治疗。17例患者接受了根治性或肿瘤细胞减灭术。9名患者接受了基于以下标准的移植物：影像学检查无肝外扩散和不可切除的症状性转移性疾病。在8名接受药物治疗的患者中，5名最初临床状况稳定的患者在转诊后仍存活32至56个月。在17例接受肝切除治疗的患者中，13例在手术后存活6至108个月，7例无病。根治性切除后，5年生存率和无病生存率分别为62%和52%。在9名移植患者中，3名因类癌肿瘤移植的患者分别在15个月、24个月和62个月存活，其中1名患者晚期复发。我们的研究结果表明，MET的治疗适应症应基于年龄、临床症状、组织学类型和肿瘤的扩展：稳定MET患者可能受益于手术限制;侵袭性MET患者的肝切除可能提供良好的长期缓解，并可能治愈三分之一的患者;肝移植应限于患有不可切除类癌MET的年轻患者，但由于既往手术和化疗栓塞，肝移植仍是一种高风险手术。
We reviewed our experience with 31 patients with metastatic endocrine tumors (METs) who were treated by different modalities. Eight patients were treated by chemotherapy or chemoembolization because of stable disease or surgical contraindications. Seventeen patients underwent curative or cytoreductive surgical resection. Nine patients received grafts based on the following criteria: no extrahepatic spread on imaging workup and nonresectable symptomatic metastatic disease. Of the eight medically treated patients, the five patients with initial stable clinical condition are alive 32 to 56 months after referral. Of the 17 patients treated by liver resection, 13 are alive 6 to 108 months after surgery, and 7 are disease-free. After curative resection, the 5-year actuarial survival and disease-free survival rates were 62% and 52%, respectively. Of the nine grafted patients, three patients grafted for carcinoid tumor are alive at 15, 24, and 62 months, one of whom has a late recurrence. Our results indicate that therapeutic indications for METs should be based on age, clinical symptoms, histologic type, and tumor extension: Patients with stable MET may benefit from surgical restraint; liver resection in patients with aggressive MET may provide good long-term palliation and possibly cure one-third of the patients; liver transplantation should be restricted to young patients with nonresectable carcinoid MET but remains a high-risk operation because of previous surgery and chemoembolization.