Chamberlain R S, Canes D, Brown K T, Saltz L, Jarnagin W, Fong Y, Blumgart L H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Am Coll Surg. 2000 Apr;190(4):432-45. doi: 10.1016/s1072-7515(00)00222-2.
In most instances, advanced neuroendocrine tumors follow an indolent course. Hepatic metastases are common, and although they can cause significant pain, incapacitating endocrinopathy, and even death, they are usually asymptomatic. The appropriate timing and efficacy of interventions, such as hepatic artery embolization (HAE) and operation, remain controversial.
The records of 85 selected patients referred for treatment of hepatic neuroendocrine tumor metastases between 1992 and 1998 were reviewed from a prospective database. A multidisciplinary group of surgeons, radiologists, and oncologists managed all patients. Overall survival among this cohort is reported and prognostic variables, which may be predictive of survival, are analyzed.
There were 37 men and 48 women, with a median age of 52 years. There were 41 carcinoid tumors, 26 nonfunctional islet cell tumors, and 18 functional islet cell tumors. Thirty-eight patients had extrahepatic metastases, and in 84% of patients, the liver metastases were bilobar. Eighteen patients were treated with medical therapy or best supportive care, 33 patients underwent HAE, and 34 patients underwent hepatic resection. Both the HAE-related mortality and the 30-day operative mortality rates were 6%. By univariate analysis, earlier resection of the primary tumor, curative intent of treatment, and initial surgical treatment were associated with prolonged survival (p < 0.05). On multivariate analysis, only curative intent to treat remained significant (p < 0.04). Patients with bilobar or more than 75% liver involvement by tumor were least likely to benefit from surgical resection. One-, 3-, and 5-year survival rates for the entire group were 83%, 61%, and 53%, respectively. The 1-, 3-, and 5-year survivals for patients treated with medical therapy, HAE, and operation were 76%, 39%, and not available; 94%, 83%, and 50%; and 94%, 83%, and 76%, respectively.
Hepatic metastases from neuroendocrine tumors are best managed with a multidisciplinary approach. Both HAE and surgical resection provide excellent palliation of hormonal and pain symptoms. In select patients, surgical resection of hepatic metastases may prolong survival, but is rarely curative.
在大多数情况下，晚期神经内分泌肿瘤进展缓慢。肝转移很常见，虽然它们可引起严重疼痛、致残性内分泌病甚至死亡，但通常无症状。肝动脉栓塞术（HAE）和手术等干预措施的合适时机和疗效仍存在争议。
从一个前瞻性数据库中回顾了1992年至1998年间因肝神经内分泌肿瘤转移而转诊接受治疗的85例选定患者的记录。由外科医生、放射科医生和肿瘤内科医生组成的多学科团队对所有患者进行管理。报告了该队列患者的总生存率，并分析了可能预测生存的预后变量。
男性37例，女性48例，中位年龄52岁。类癌41例，无功能性胰岛细胞瘤26例，功能性胰岛细胞瘤18例。38例患者有肝外转移，84%的患者肝转移为双侧。18例患者接受药物治疗或最佳支持治疗，33例患者接受HAE，34例患者接受肝切除术。HAE相关死亡率和30天手术死亡率均为6%。单因素分析显示，原发肿瘤的早期切除、治疗的根治性意图和初始手术治疗与生存期延长相关（p<0.05）。多因素分析显示，只有治疗的根治性意图仍然显著（p<0.04）。肿瘤累及双侧或肝脏超过75%的患者从手术切除中获益的可能性最小。整个组的1年、3年和5年生存率分别为83%、61%和53%。接受药物治疗、HAE和手术治疗的患者的l年、3年和5年生存率分别为76%、39%（5年生存率未提供）；94%、83%和50%；以及94%、83%和76%。
神经内分泌肿瘤肝转移最好采用多学科方法进行管理。HAE和手术切除均可有效缓解激素和疼痛症状。在部分患者中，肝转移灶的手术切除可能延长生存期，但很少能治愈。
