Risk factors affecting prognosis in metachronous liver metastases from WHO classification G1 and G2 gastroenteropancreatic neuroendocrine tumors after initial R0 surgical resection
Risk factors affecting prognosis in metachronous liver metastases from WHO classification G1 and G2 gastroenteropancreatic neuroendocrine tumors after initial R0 surgical resection
复制标题
影响初次 R0 手术切除后 WHO 分类 G1 和 G2 胃肠胰神经内分泌肿瘤异时性肝转移预后的危险因素
DOI：
10.1186/s12885-019-5457-z
复制
发表时间：
2019-04-08
期刊：
影响因子：
3.8
通讯作者：
Huang, Cheng
中科院分区：
文献类型：
--
作者：
Lv, Yang;Han, Xu;Huang, Cheng
背景在此我们描述胃肠胰腺神经内分泌肿瘤异时转移的治疗和预后在中国的一个大型中心，108例患者的临床病理数据和生存结果显示，（平均年龄，54.0岁）伴异时性肝转移性GEP-对2003年8月至2014年7月期间最初使用R 0手术切除治疗的NETs疾病进行了单向比较，生存分析，结果55例（50.9%）胰腺NETs和92例（85.2%）G2原发肿瘤。对于肝转移瘤的治疗，48例（44.4%）患者接受了肝脏定向局部治疗（肝切除术、射频消融术、经导管动脉化疗栓塞术等），15例（13.9%）接受了系统治疗（干扰素、生长抑素类似物等），45例（41.7%）同时接受两种治疗。多因素分析显示，OS与肝肿瘤数量（P< 0.001）、治疗方式（P= 0.045）和转移灶与原发灶之间Ki-67指数升高（P= 0.027）相关。预测诺模图C指数为0.63。结论Ki-67指数在转移瘤中高于原发瘤是预后不良的独立因素。局部治疗与肝转移性GEP-NET患者的生存期延长相关。应根据临床病理特征制定最佳治疗策略。
BackgroundHere we describe the treatments and prognosis for metachronous metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) after initial R0 surgical resection at a large center in China.MethodsThe clinicopathological data and survival outcomes for 108 patients (median age, 54.0 years) with metachronous hepatic metastatic GEP-NETs disease who were initially treated using R0 surgical resection between August 2003 and July 2014 were analyzed using one-way comparisons, survival analysis, and a predictive nomogram.ResultsFifty-five (50.9%) patients had pancreatic NETs and 92 (85.2%) had G2 primary tumors. For treatment of the hepatic metastases, 48 (44.4%) patients received liver-directed local treatment (metastasectomy, radiofrequency ablation, transcatheter arterial chemoembolization, etc.), 15 (13.9%) received systemic treatment (interferon, somatostatin analogs, etc.), and 45 (41.7%) received both treatments. Multivariable analyses revealed that OS was associated with hepatic tumor number (P< 0.001), treatment modality (P= 0.045), and elevated Ki-67 index between the metastatic and primary lesions (P= 0.027). The predictive nomogram C-index was 0.63.ConclusionsA higher Ki-67 index in metastases compared to primary tumor was an independent factor for poor prognosis. Local treatment was associated with prolonged survival of hepatic metastatic GEP-NET patients. Optimal treatment strategies based on clinicopathological characteristics should be developed.