Endocrine tumours of the gastrointestinal tract. Transplantation in the management of metastatic endocrine tumours.
Endocrine tumours of the gastrointestinal tract. Transplantation in the management of metastatic endocrine tumours.
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胃肠道内分泌肿瘤。
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
P. Neuhaus
中科院分区：
文献类型：
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作者：
A. Pascher;J. Klupp;P. Neuhaus
患有神经内分泌肿瘤的患者通常表现为同步肝转移或在其疾病过程中发生肝转移。完全切除肝转移瘤以达到治愈的目的，可以通过肝切除术来实现，或者如果肝脏疾病扩散或激素症状和疼痛无法通过医学控制，则可以通过全肝切除术和移植来实现。原位肝移植治疗转移性神经内分泌肿瘤疾病的适应症应采用多模式和多学科的治疗方法。到目前为止，已经发表了大约120-130例原位肝移植治疗神经内分泌肿瘤的病例，但移植后的随访有限，大多数报告包括少数患者。在考虑已发表的研究和数据后，可能会给出一些建议，尽管这些建议是基于低水平的证据。在通过影像学检查和诊断性腹腔镜检查排除肝外肿瘤表现后，应严格选择适应症。在一项大型回顾性分析中，通过多变量分析确定了一些预后标志物，例如年龄低于50岁和没有同时进行广泛手术。原发性肿瘤定位的预后影响仍然是有争议的。然而，还需要进一步的有利的长期预后指标。以Ki 67和E-cadherin表达为特征的肿瘤生物学可能有助于识别具有有利结果的患者，从而可以改善患者选择，但这需要在更大的患者队列中进一步评估。对于病情缓解或病情稳定的患者，在药物治疗下进行原位肝移植，以及出于姑息性原因进行原位肝移植，应仅限于选定的个别病例。
Patients with neuroendocrine tumours often present with synchronous liver metastases or develop hepatic metastases in the course of their disease. A complete removal of liver metastases with an intention to cure may be accomplished by liver resection or, if hepatic disease is disseminated or hormonal symptoms and pain cannot be controlled medically, by total hepatectomy and transplantation. The indications for orthotopic liver transplantation for metastatic neuroendocrine tumour disease should be anchored in a multimodal and multidisciplinary therapeutic approach. Approximately, 120-130 cases of orthotopic liver transplantation for neuroendocrine tumours have been published so far, but follow-up after transplantation has been limited, and most reports comprise a small number of patients. After considering published studies and data, some recommendations may be given, although these are based on a low level of evidence. After excluding extrahepatic tumour manifestations by imaging procedures and diagnostic laparoscopy, the indication should be chosen restrictively. Few prognostic markers, for example age below 50 years and absence of concurrent extensive surgery, were identified by multivariate analysis in a large retrospective analysis. The prognostic impact of primary tumour localisation is still controversial. However, further indicators of favourable long-term prognosis are needed. Tumour biology characterised by Ki67 and E-cadherin expression may help to identify patients with a favourable outcome so that patient selection can be improved, but this needs further evaluation in larger patient cohorts. Orthotopic liver transplantation for patients with remission of disease or stable disease under medical treatment, and orthotopic liver transplantation for palliative reasons, should be restricted to selected individual cases.