Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis
Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis
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DOI：
10.1245/s10434-010-1154-5
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发表时间：
2010-12-01
影响因子：
3.7
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Mayo, Skye C.;de Jong, Mechteld C.;Pawlik, Timothy M.
神经内分泌肿瘤肝转移（NELM）的管理仍然存在争议，一些人主张积极的手术方法，而另一些人则采取了更保守的策略。我们试图在一个大型的多中心国际患者队列中确定手术治疗NELM的疗效，我们从8个主要肝胆中心的国际数据库中确定了1985年至2009年接受NELM手术治疗的339例患者。采用Kaplan-Meier和考克斯回归模型对相关临床病理资料进行评估，大多数患者原发于胰腺（40%）或小肠（25%）神经内分泌肿瘤（NET）。大多数患者（60%）患有双侧肝病。手术时，78%的患者接受了肝切除术，3%的患者接受了单纯消融术，19%的患者接受了切除+消融术。45%的患者进行了大肝切除术，14%的患者进行了第二次肝手术。类癌是最常见的NET组织学亚型（53%）。中位生存期为125个月，5年和10年总生存率分别为74%和51%。5年时94%的患者疾病复发。接受R 0/R1切除术的神经功能性NET患者从手术中获益最多（P = 0.01）。在多变量分析中，同步性疾病[风险比（HR）= 1.9]、非功能性NET激素状态（HR = 2.0）和肝外疾病（HR = 3.0）仍然预测生存率较差（所有P < 0.05）。无肝外或同时性疾病的有功能性肝转移的患者从手术治疗中获得最大的生存益处。
Management of neuroendocrine tumor liver metastasis (NELM) remains controversial, with some advocating an aggressive surgical approach while others have adopted a more conservative strategy. We sought to define the efficacy of the surgical management of NELM in a large multicenter international cohort of patients.We identified 339 patients who underwent surgical management for NELM from 1985 to 2009 from an international database of eight major hepatobiliary centers. Relevant clinicopathologic data were assessed using Kaplan-Meier and Cox regression models.Most patients had a pancreatic (40%) or small bowel (25%) neuroendocrine tumor (NET) primary. The majority of patients (60%) had bilateral liver disease. At surgery, 78% of patients underwent hepatic resection, 3% ablation alone, and 19% resection + ablation. Major hepatectomy was performed in 45% of patients, and 14% underwent a second liver operation. Carcinoid was the most common NET histological subtype (53%). Median survival was 125 months, with overall 5- and 10-year survival of 74%, and 51%, respectively. Disease recurred in 94% of patients at 5 years. Patients with hormonally functional NET who had R0/R1 resection benefited the most from surgery (P = 0.01). On multivariate analyses, synchronous disease [hazard ratio (HR) = 1.9], nonfunctional NET hormonal status (HR = 2.0), and extrahepatic disease (HR = 3.0) remained predictive of worse survival (all P < 0.05).Liver-directed surgery for NELM is associated with prolonged survival; however, the majority of patients will develop recurrent disease. Patients with hormonally functional hepatic metastasis without prior extrahepatic or synchronous disease derive the greatest survival benefit from surgical management.